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 .
Implementation of evidence-based antenatal care in Mozambique: a cluster randomized controlled trial: study protocol
Background Antenatal care ( ANC ) reduces maternal and perinatal morbidity and mortality directly through the detection and treatment of pregnancy-related illnesses , and indirectly through the detection of women at increased risk of delivery complications . The potential benefits of quality antenatal care services are most significant in low-re source countries where morbidity and mortality levels among women of reproductive age and neonates are higher . WHO developed an ANC model that recommended the delivery of services scientifically proven to improve maternal , perinatal and neonatal outcomes . The aim of this study is to determine the effect of an intervention design ed to increase the use of the package of evidence -based services  included in the WHO ANC model in Mozambique . The primary hypothesis is that the intervention will increase the use of evidence -based practice s during ANC visits in comparison to the st and ard dissemination channels currently used in the country . Methods This is a demonstration project to be developed through a facility-based cluster r and omized controlled trial with a stepped wedge design . The intervention was tailored , based on formative research findings , to be readily applicable to local prenatal care services and acceptable to local pregnant women and health providers . The intervention includes four components : the provision of kits with all necessary medicines and laboratory supplies for ANC ( medical and non-medical equipment ) , a storage system , a tracking system , and training sessions for health care providers .  Ten clinics were selected and will start receiving the intervention in a r and om order . Outcomes will be computed at each time point when a new clinic starts the intervention . The primary outcomes are the delivery of selected health care practice s to women attending the first ANC visit , and secondary outcomes are the delivery of selected health care practice s to women attending second and higher ANC visits as well as the attitude of midwives in relation to adopting the practice s. This demonstration project is pragmatic in orientation and will be conducted under routine conditions . Discussion There is an urgent need for effective and sustainable scaling-up approaches of health interventions in low-re source countries . This can only be accomplished by the engagement of the country ’s health stakeholders at all levels . This project aims to achieve improvement in the quality of antenatal care in Mozambique through the implementation of a multifaceted intervention on three levels : policy , organizational and health care delivery levels . The implementation of the trial will probably require a change in accountability and behaviour of health care providers and we expect this change in ‘ habits ’ will contribute to obtaining reliable health indicators , not only related to research issues , but also to health care outcomes derived from the new health care model . At policy level , the results of this study may suggest a need for revision of the supply chain management system . Given that supply chain management is a major challenge for many low-re source countries , we envisage that important lessons on how to improve the supply chain in Mozambique and other similar setting s , will be drawn from this study .Trial registration Pan African Clinical Trial Registry data base . Identification number : PACTR201306000550192
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 .