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 .
The Impact of an Intervention to Improve Malaria Care in Public Health Centers on Health Indicators of Children in Tororo, Uganda (PRIME): A Cluster-Randomized Trial
Optimizing quality of care for malaria and other febrile illnesses is a complex challenge of major public health importance . To evaluate the impact of an intervention aim ing to improve malaria case management on the health of community children , a cluster-r and omized trial was conducted from 2010–2013 in Tororo , Ug and a , where malaria transmission is high . Twenty public health centers were included ; 10 were r and omized in a 1:1 ratio to intervention or control . Households within 2 km of health centers provided the sampling frame for the evaluation . The PRIME intervention included training in fever case management using malaria rapid diagnostic tests ( mRDTs ) , patient-centered services , and health center management ; plus provision of mRDTs and artemether – lumefantrine . Cross-sectional community surveys were conducted at baseline and endline ( N = 8,766 ) , and a cohort of children was followed for approximately 18 months ( N = 992 ) . The primary outcome was prevalence of anemia ( hemoglobin < 11.0 g/dL ) in children under 5 years of age in the final community survey . The intervention was delivered successfully ; however , no differences in prevalence of anemia or parasitemia were observed between the study arms in the final community survey or the cohort . In the final survey , prevalence of anemia in children under 5 years of age was 62.5 % in the intervention versus 63.1 % in control ( adjusted risk ratio = 1.01 ; 95 % confidence interval = 0.91–1.13 ; P = 0.82 ) . The PRIME intervention , focusing on training and commodities , did not produce the expected health benefits in community children in Tororo . This challenges common assumptions that improving quality of care and access to malaria diagnostics will yield health gains
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 .