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 feeding and growth of HIV-positive children through nutrition training of frontline health workers in Tanga, Tanzania
Background Nutrition training can boost competence of health workers to improve children ’s feeding practice s. In this way , child undernutrition can be ameliorated in general population s. However , evidence is lacking on efficacy of such interventions among Human Immunodeficiency Virus (HIV)-positive children . We aim ed to examine the efficacy of a nutrition training intervention to improve midlevel providers ’ ( MLPs ) nutrition knowledge and feeding practice s and the nutrition statuses of HIV-positive children in Tanga , Tanzania . Methods This cluster-r and omized controlled trial was conducted in 16 out of 32 care and treatment centers ( CTCs ) in Tanga . Eight CTCs were assigned to the intervention arm and a total of 16 MLPs received nutrition training and provided nutrition counseling and care to caregivers of HIV-positive children . A total of 776 pairs of HIV-positive children and their caregivers were recruited , of whom 397 were in the intervention arm . Data were analyzed using instrumental variable r and om effects regression with panel data to examine the efficacy of the intervention on nutrition status through feeding practice s. Results Mean nutrition knowledge scores were higher post-training compared to pre-training among MLPs ( 37.1 vs. 23.5 , p < 0.001 ) . A mean increment weight gain of 300 g was also observed at follow-up compared to baseline among children of the intervention arm . Feeding frequency and dietary diversity improved following the intervention and a 6 months follow-up ( p < 0.001 ) . An increase in each unit of feeding frequency and dietary diversity were associated with a 0.15-unit and a 0.16-unit respectively decrease in the child underweight ( p < 0.001 ) . Conclusions Nutrition training improved nutrition knowledge among MLPs caring for HIV-positive children attending CTCs in Tanga , Tanzania . Caregivers ’ feeding practice s also improved , which in turn led to a modest weight gain among HIV-positive children . To sustain weight gain , efforts should be made to also improve households ’ food security and caregivers ’ education in addition to inservice nutrition trainings . The protocol was registered on 15/02/2013 , before the recruitment at IS RCT N trial registry with the trial registration number : IS RCT N65346364
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 .