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 .
Communication training and patient satisfaction: A randomized trial study from Mashhad, Iran
Background In many healthcare systems , client satisfaction has been considered as an important indicator of primary healthcare quality . Hence communication education might be leading to better quality of family planning services and higher client satisfaction . This study aim ed to evaluate to what extent the communication skills training program could improve client satisfaction . Methods This was a r and omized controlled trial undertaken in health centers of Mashhad University Medical Sciences , Mashhad , Iran from July to September 2004 . Eligible participants were from two population targets , including healthcare providers and their clients . All 35 health centers were r and omly divided into intervention ( n = 17 ) and control groups ( n = 18 ) . The healthcare providers were working in intervention centers ( n = 24 ) not in control centers ( n = 27 ) received an additional communication skills training program in spite of routine education . Data regarding communication knowledge , attitude , and skills from healthcare providers and the satisfaction rate from the their clients ( n = 47 client for each group ) were collected at two time points . Results This study showed that communication knowledge and skills of health workers improved significantly in the intervention group ( P < 0.05 ) . Furthermore the score of client satisfaction was significantly improved in the intervention group after 1 month follow-up ( p < 0.05 ) . Conclusion The communication skills training program is an effective intervention and may improve the satisfaction rate of clients
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 .