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 .
Simulated patient encounters to improve adolescent retention in HIV care in Kenya: study protocol of a stepped-wedge randomized controlled trial
Background Adolescent-friendly policies aim to tailor HIV services for adolescents and young adults aged 10–24 years ( AYA ) to promote health outcomes and improve retention in HIV care and treatment . However , few interventions focus on improving healthcare worker ( HCW ) competencies and skills for provision of high- quality adolescent care . St and ardized patients ( SPs ) are trained actors who work with HCWs in mock clinical encounters to improve clinical assessment , communication , and empathy skills . This stepped-wedge r and omized controlled trial will evaluate a clinical training intervention utilizing SPs to improve HCW skills in caring for HIV-positive AYA , result ing in increased retention in care . Methods / design The trial will utilize a stepped-wedge design to evaluate a training intervention using SPs to train HCWs in assessment , communication , and empathy skills for AYA HIV care . We will recruit 24 clinics in Kenya with an active electronic medical record ( EMR ) system and at least 40 adolescents enrolled in HIV care per site . Stratified r and omization by county will be used to assign clinics to one of four waves – time periods when they receive the intervention – with each wave including six clinics . From each clinic , up to 10 HCWs will participate in the training intervention . SP training includes didactic sessions in adolescent health , current guidelines , communication skills , and motivational interviewing techniques . HCW participants will rotate through seven st and ardized SP scenarios , followed by SP feedback , group debriefing , and remote expert evaluation . AYA outcomes will be assessed using routine clinic data . The primary outcome is AYA retention in HIV care , defined as returning for first follow-up visit within 6 months of presenting to care , or returning for a first follow-up visit after re-engagement in care in AYA with a previous history of being lost to follow-up . Secondary outcomes include HCW competency scores , AYA satisfaction with care , and AYA clinical outcomes including CD4 and viral load . Additional analyses will determine cost-effectiveness of the intervention . Discussion This trial will contribute valuable information to HIV programs in Kenya and other low-re source setting s , providing a potentially scalable strategy to improve quality of care and retention in critical HIV services in this population .Trial registration Clinical Trials.gov , ID : NCT02928900 . Registered 26 August 2016
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 .