The evidence is concentrated in two types of PMM strategies : implementation strategies ( in-service training , continuing education , supervision ) and performance-based financing .
Major gaps exist in accountability arrangements particularly the use of audit and feedback .
The least studied types of outcomes were unintended effects , harm and social equity .
Conclusions The evidence is clustered around interventions that are unlikely to achieve transformational change in health outcomes .
The gaps identified suggest that routinely used PMM strategies are implemented without sufficient knowledge of their effects .
Introduction We mapped available evidence on  performance measurement and management ( PMM ) strategies in primary healthcare ( PHC ) systems of low-income and middle-income countries ( LMICs ) .
Widely used , their effectiveness remains inconclusive .
This evidence gap map characterises existing research and evidence gaps .
A multifaceted intervention to improve health worker adherence to integrated management of childhood illness guidelines in Benin.
OBJECTIVES We evaluated an intervention to support health workers after training in Integrated Management of Childhood Illness ( IMCI )  , a strategy that can improve outcomes for children in developing countries by encouraging workers ' use of evidence -based guidelines for managing the leading causes of child mortality . METHODS We conducted a r and omized trial in Benin . We administered a survey in 1999 to assess health care quality before IMCI training . Health workers then received training plus either study supports ( job aids , nonfinancial incentives , and supervision of workers and supervisors ) or usual supports . Follow-up surveys conducted in 2001 to 2004 assessed recommended treatment , recommended or adequate treatment , and an index of overall guideline adherence . RESULTS We analyzed 1244 consultations .  Performance improved in both intervention and control groups , with no significant differences between groups . However , training proceeded slowly , and low- quality care from health workers without IMCI training diluted intervention effects . Per- protocol analyses revealed that workers with IMCI training plus study supports provided better care than did those with training plus usual supports ( 27.3 percentage-point difference for recommended treatment ; P < .05 ) , and both groups outperformed untrained workers . CONCLUSIONS IMCI training was useful but insufficient . Relatively inexpensive supports can lead to additional improvements
The evidence is concentrated in two types of PMM strategies : implementation strategies ( in-service training , continuing education , supervision ) and performance-based financing .
Major gaps exist in accountability arrangements particularly the use of audit and feedback .
The least studied types of outcomes were unintended effects , harm and social equity .
Conclusions The evidence is clustered around interventions that are unlikely to achieve transformational change in health outcomes .
The gaps identified suggest that routinely used PMM strategies are implemented without sufficient knowledge of their effects .
Introduction We mapped available evidence on  performance measurement and management ( PMM ) strategies in primary healthcare ( PHC ) systems of low-income and middle-income countries ( LMICs ) .
Widely used , their effectiveness remains inconclusive .
This evidence gap map characterises existing research and evidence gaps .