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 .
Strengthening health human resources and improving clinical outcomes through an integrated guideline and educational outreach in resource-poor settings: a cluster-randomized trial
Background In low-income countries , only about a third of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome ( HIV/AIDS ) patients eligible for anti-retroviral treatment currently receive it . Providing de central ized treatment close to where patients live is crucial to a faster scale up , however , a key obstacle is limited health system capacity due to a shortage of trained health-care workers and challenges of integrating HIV/AIDS care with other primary care services ( e.g. tuberculosis , malaria , respiratory conditions ) . This study will test an adapted primary care health care worker training and guideline intervention , Practical Approach to Lung Health and HIV/AIDS Malawi ( PALM PLUS ) , on staff retention and satisfaction , and quality of patient care . Methods / Design A cluster-r and omized trial design is being used to compare usual care with a st and ardized clinical guideline and training intervention , PALM PLUS . The intervention targets middle-cadre health care workers ( nurses , clinical officers , medical assistants ) in 30 rural primary care health centres in a single district in Malawi .  PALM PLUS is an integrated , symptom-based and user-friendly guideline consistent with Malawian national treatment protocol s. Training is st and ardized and based on an educational outreach approach . Trainers will be front-line peer healthcare workers trained to provide outreach training and support to their fellow front-line healthcare workers during focused ( 1 - 2 hours ) , intermittent , interactive sessions on-site in health centers . Primary outcomes are health care worker retention and satisfaction . Secondary outcomes are clinical outcomes measured at the health centre level for HIV/AIDS , tuberculosis , prevention-of-mother-to-child-transmission of HIV and other primary care conditions . Effect sizes and 95 % confidence intervals for outcomes will be presented . Assessment of outcomes will occur at 1 year post- implementation . Discussion The PALM PLUS trial aims to address a key problem : strengthening middle-cadre health care workers to support the broader scale up of HIV/AIDS services and their integration into primary care . The trial will test whether the PALM PLUS intervention improves staff satisfaction and retention , as well as the quality of patient care , when compared to usual practice .Trial Registration Current controlled Trials : IS RCT
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 .