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 community case management of diarrhoea and pneumonia in district Badin, Pakistan through a cluster randomised study—the NIGRAAN trial protocol
Background Diarrhoea and pneumonia contribute 30 % of deaths in children under 5 in Pakistan . Pakistan ’s Lady Health Workers Programme ( LHW-P ) covers about 60 % of the population but has had little impact in reducing morbidity and mortality related to these major childhood killers . An external evaluation of the LHW-P suggests that lack of supportive supervision of LHWs by lady health supervisors ( LHSs ) is a key determinant of this problem . Project NIGRAAN aims to improve knowledge and skills of LHWs and community caregivers through supervisory strategies employed by LHSs . Ultimately , community case management ( CCM ) of childhood pneumonia and diarrhoea will improve . Methods / Design NIGRAAN is a cluster-r and omised trial in District Badin , Pakistan . There are approximately 1100 LHWs supervised by 36 LHSs in Badin . For this study , each LHS serves as a cluster . All LHSs working permanently in Badin who regularly conduct and report field visits are eligible . Thirty-four LHSs have been allocated to either intervention or control arms in a ratio of 1:1 through computer-generated simple r and omisation technique . Five LHWs from each LHSs are also r and omly picked . All 34 LHSs and 170 LHWs will be actively monitored . The intervention consists of training to build LHS knowledge and skills , clinical mentorship and written feedback to LHWs . Pre- and post-intervention assessment s of LHSs , LHWs and community caregivers will be conducted via focus group discussion s , in-depth interviews , knowledge assessment question naires , skill assessment scorecards and household surveys . Primary outcome is improvement in CCM practice s of childhood diarrhoea and pneumonia and will be assessed at the cluster level . Discussion NIGRAAN takes a novel approach to implementation research and explores whether training of LHSs in supervisory skills results in improving the CCM practice s of childhood diarrhoea and pneumonia . No significant harm to participants is anticipated . The enablers and barriers towards improved CCM would provide recommendations to policymakers for scale up of this intervention nationally and regionally . Trial registration NIGRAAN is registered with the ‘ Australian New Zeal and Clinical Trials Registry ’ . Registration Number :
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 .