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 .
Cluster-randomized Trial of Infant Nutrition Training for Caries Prevention
The objective of this study was to estimate the caries impact of providing training in infant feeding guidelines to workers at Brazilian public primary care clinics . In a cluster-r and omized controlled trial ( n = 20 clinics ) , health care workers either were trained in guidelines for infant nutrition , stressing healthful complementary feeding , or were assigned to a ‘ usual practice s ’ control , which allowed for maternal counseling at practitioner discretion . Training occurred once ; the amount of counseling provided to mothers was not assessed . Eligible pregnant women were enrolled to follow health outcomes in their children .  Early childhood caries ( ECC ) was measured at age three years ( n = 458 children ) . The overall reductions in ECC ( relative risk , 0.92 ; 95%CI , 0.75 , 1.12 ) and severe ECC ( RR , 0.87 ; 95%CI , 0.64 , 1.19 ) were not statistically significant . There was a protective effect among mothers who remained exclusively at the same health center ( S-ECC RR , 0.68 ; 95%CI , 0.47 , 0.99 ) and among those naming the health center as their principal source of feeding advice ( S-ECC RR , 0.53 ; 95%CI , 0.29 , 0.97 ) . Health care worker training did not yield a statistically significant reduction in caries overall , although caries was reduced among children of mothers more connected to their health centers ( Clinical Trials.gov NCT00635453 )
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 .