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 .
Effectiveness of the WHO Safe Childbirth Checklist program in reducing severe maternal, fetal, and newborn harm in Uttar Pradesh, India: study protocol for a matched-pair, cluster-randomized controlled trial
Background Effective , scalable strategies to improve maternal , fetal , and newborn health and reduce preventable morbidity and mortality are urgently needed in low- and middle-income countries . Building on the successes of previous checklist-based programs , the World Health Organization ( WHO ) and partners led the development of the Safe Childbirth Checklist ( SCC ) , a 28-item list of evidence -based practice s linked with improved maternal and newborn outcomes . Pilot-testing of the Checklist in Southern India demonstrated dramatic improvements in adherence by health workers to essential childbirth-related practice s ( EBPs ) . The BetterBirth Trial seeks to measure the effectiveness of SCC impact on EBPs , deaths , and complications at a larger scale . Methods / design This matched-pair , cluster-r and omized controlled , adaptive trial will be conducted in 120 facilities across 24 districts in Uttar Pradesh , India . Study sites , identified according to predefined eligibility criteria , were matched by measured covariates before r and omization . The intervention , the SCC embedded in a quality improvement program , consists of leadership engagement , a 2-day educational launch of the SCC , and support through placement of a trained peer “ coach ” to provide supportive supervision and real-time data feedback over an 8-month period with decreasing intensity . A facility-based childbirth quality coordinator is trained and supported to drive sustained behavior change after the BetterBirth team leaves the facility . Study participants are birth attendants and women and their newborns who present to the study facilities for childbirth at 60 intervention and 60 control sites . The primary outcome is a composite measure including maternal death , maternal severe morbidity , stillbirth , and newborn death , occurring within 7 days after birth . The sample size ( n = 171,964 ) was calculated to detect a 15 % reduction in the primary outcome . Adherence by health workers to EBPs will be measured in a subset of births ( n = 6000).The trial will be conducted in close collaboration with key partners including the Governments of India and Uttar Pradesh , the World Health Organization , an expert Scientific Advisory Committee , an experienced local implementing organization ( Population Services International , PSI ) , and frontline facility leaders and workers . Discussion If effective , the WHO Safe Childbirth Checklist program could be a powerful health facility-strengthening intervention to improve quality of care and reduce preventable harm to women and newborns , with millions of potential beneficiaries . Trial registration BetterBirth Study Protocol date d : 13 February 2014 ; Clinical Trials.gov : NCT02148952 ; Universal Trial Number : U1111 - 1131 - 5647
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 .