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 .
An educational intervention to promote appropriate complementary feeding practices and physical growth in infants and young children in rural Haryana, India.
Complementary feeding practice s are often inadequate in developing countries , result ing in a significant nutritional decline between 6 and 18 mo of age . We assessed the effectiveness of an educational intervention to promote adequate complementary feeding practice s that would be feasible to sustain with existing re sources . The study was a cluster r and omized controlled trial in communities in the state of Haryana in India . We developed the intervention through formative research . Eight communities were pair matched on their baseline characteristics ; one of each pair was r and omly assigned to receive the intervention and the other to no specific feeding intervention . Health and nutrition workers in the intervention communities were trained to counsel on locally developed feeding recommendations .  Newborns were enrolled in all of the communities ( 552 in the intervention and 473 in the control ) and followed up every 3 mo to the age of 18 mo . The main outcome measures were weights and lengths at 6 , 9 , 12 , and 18 mo and complementary feeding practice s at 9 and 18 mo . All analyses were by intent to treat . In the overall analyses , there was a small but significant effect on length gain in the intervention group ( difference in means 0.32 cm , 95 % CI , 0.03 , 0.61 ) . The effect was greater in the subgroup of male infants ( difference in mean length gain 0.51 cm , 95 % CI 0.03 , 0.98 ) . Weight gain was not affected . Energy intakes from complementary foods overall were significantly higher in the intervention group children at 9 mo ( mean + /- SD : 1556 + /- 1109 vs. 1025 + /- 866 kJ ; P < 0.001 ) and 18 mo ( 3807 + /- 1527 vs. 2577 + /- 1058 kJ ; P < 0.001 ) . Improving complementary feeding practice s through existing services is feasible but the effect on physical growth is limited . Factors that limit physical growth in such setting s must be better understood to plan more effective nutrition programs
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 .