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 .
Improving Facility Performance in Infectious Disease Care in Uganda: A Mixed Design Study with Pre/Post and Cluster Randomized Trial Components
Background The effects of two interventions , Integrated Management of Infectious Disease ( IMID ) training program and On-Site Support ( OSS ) , were tested on 23 facility performance indicators for emergency triage assessment and treatment ( ETAT ) , malaria , pneumonia , tuberculosis , and HIV . Methods The trial was implemented in 36 primary care facilities in Ug and a. From April 2010 , two mid-level practitioners per facility participated in IMID training .  Eighteen of 36 facilities were r and omly assigned to Arm A , and received OSS in 2010 ( nine monthly two-day sessions ) ; 18 facilities assigned to Arm B did not receive OSS in 2010 . Data were collected from Nov 2009 to Dec 2010 using a revised Ministry of Health outpatient medical form and nine registers . We analyzed the effect of IMID training alone by measuring changes before and during IMID training in Arm B , the combined effect of IMID training and OSS by measuring changes in Arm A , and the incremental effect of OSS by comparing changes across Arms A and B. Results IMID training was associated with statistically significant improvement in three indicators : out patients triaged ( adjusted relative risks ( aRR ) = 1.29 , 99%CI = 1.01,1.64 ) , emergency and priority patients admitted , detained , or referred ( aRR = 1.59 , 99%CI = 1.04,2.44 ) , and pneumonia suspects assessed ( aRR = 2.31 , 99%CI = 1.50,3.55 ) . IMID training and OSS combined was associated with improvements in six indicators : three ETAT indicators ( out patients triaged ( aRR = 2.03 , 99%CI = 1.13,3.64 ) , emergency and priority patients admitted , detained or referred ( aRR = 3.03 , 99%CI = 1.40,6.56 ) , and emergency patients receiving at least one appropriate treatment ( aRR = 1.77 , 99%CI = 1.10,2.84 ) ) ; two malaria indicators ( malaria cases receiving appropriate antimalarial ( aRR = 1.50 , 99%CI = 1.04,2.17 ) , and patients with negative malaria test results prescribed antimalarial ( aRR = 0.67 , 99%CI = 0.46,0.97 ) ) ; and enrollment in HIV care ( aRR = 1.58 , 99%CI = 1.32,1.89 ) . OSS was associated with incremental improvement in emergency patients receiving at least one appropriate treatment ( adjusted ratio of RR = 1.84,99%CI = 1.09,3.12 ) . Conclusion The trial showed that the OSS intervention significantly improved performance in one of 23 facility indicators
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 .