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 .
Practical approach to lung health in Nepal: better prescribing and reduction of cost.
OBJECTIVES To assess the impact of Practical Approach to Lung Health ( PAL ) guidelines on prescription behaviour and the total cost of prescription for patients with asthma , chronic obstructive pulmonary disease and pneumonia . METHODS Pre- and post-intervention comparison in a cluster r and omized trial of primary care facilities . Seven health posts and 33 subhealth posts in Nepal were stratified by type and r and omized into intervention and control groups . Health workers from the intervention facilities received 5 days training on the adapted PAL guidelines and their use . To collect prescription details , we used carbon-copy prescription pads in both groups . To measure the impact of PAL guidelines  we used the World Health Organization 's rational use of drug indicators and drug cost indicators , in a multivariate regression analysis . RESULTS The PAL guidelines led to fewer prescriptions of multiple drugs and to more prescriptions of generic and essential drugs . The guidelines also lowered average prescription cost and wastage by disease except for chronic obstructive pulmonary disease although not to a statistically significant degree . Similarly , the prescription of antibiotics and adherence to guidelines improved , albeit not statistically significant . CONCLUSION There is evidence that the implementation of PAL guidelines promotes rational use of drugs for some respiratory diseases . The expected health effects of PAL guidelines should be compared with their implementation costs before continuing training on lung health , and strategies put in place to sustain the effects
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 .