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 .
In a rural area of Bangladesh, traditional birth attendant training improved early infant feeding practices: a pragmatic cluster randomized trial
In rural Bangladesh , most births take place at home . There is little evidence regarding the influence of traditional birth attendants ( TBAs ) or community volunteers ( CVs ) on early infant feeding practice s. We conducted a pragmatic cluster r and omized controlled trial in Panchagarh District to examine the effects of training and post-training supervision of TBAs/CVs on early breastfeeding practice s. Nine unions were r and omized into three groups of three unions . We compared outcomes between mothers in a control group ( CG ) , those living in unions where TBAs/CVs had received a 5-day training in early feeding practice s ( TG ) and those living in unions where TBAs/CVs were both trained and supervised ( SG ) . A total of 1182 mothers of infants aged 0 - 6 months were interviewed at baseline . After 6 months of intervention , an endline survey was conducted on a different sample of 1148 mothers of infants aged 0 - 6 months in the same areas . In both intervention areas , TBAs/CVs made regular home visits and attended births whenever possible . Rates of early initiation of breastfeeding , avoidance of prelacteal feeds and exclusive breastfeeding were compared between groups using cluster-controlled mixed model logistic regression . At endline , both intervention groups had significantly higher proportions of mothers who reported early initiation of breastfeeding ( CG : 88 % , TG : 96 % , SG : 96 % ) and avoidance of prelacteal feeds ( CG : 48 % , TG : 80 % , SG : 88 % ) compared with the control group ; there were no significant differences between the two intervention groups . The endline rates of reported exclusive breastfeeding were not significantly different among groups ( CG : 67 % , TG : 76 % , SG : 83 % )
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 .