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 .
Effect of provision of home-based curative health services by public sector health-care providers on neonatal survival: a community-based cluster-randomised trial in rural Pakistan
Summary Background Although the effectiveness of community mobilisation and promotive care delivered by community health workers in reducing perinatal and neonatal mortality is well established , evidence in support of home-based neonatal resuscitation and infection management is mixed . We assessed the effectiveness of adding training in neonatal bag and mask resuscitation and oral antibiotic therapy for suspected neonatal infections to a basic preventive and promotive interventions package delivered by public sector community-based lady health workers ( LHWs ) in rural Pakistan . Methods We did a cluster-r and omised controlled trial in two subdistricts of Naushahro Feroze in rural Sindh , Pakistan , between April 15 , 2009 , and Dec 10 , 2012 . LHWs , trained in basic newborn resuscitation and in recognition and treatment ( with oral amoxicillin ) of suspected neonatal respiratory infections , were linked with traditional birth attendants and encouraged to attend home births . Control clusters received routine care through the existing national programme . The primary outcome was all-cause neonatal mortality . Independent data collection teams recorded data for all pregnancies and their outcomes , morbidity , mortality , and household practice s related to maternal and newborn care . Findings Of the 27 r and omised clusters with functional LHW programmes , 13 were allocated to the intervention group ( n=242 749 ) and 14 to the control group ( n=256 985 ) . In the intervention group , LHWs did 80 % of the planned community mobilisation sessions , but were able to attend only 1184 ( 14 % ) of 8425 deliveries and 4318 ( 25 % ) of 17 288 neonatal visits within 72 h of birth ( p<0·0001 for both variables compared with the control group ) . The neonatal mortality rate was 42 deaths per 1000 livebirths in intervention clusters compared with 55 per 1000 in the control group ( risk ratio 0·80 , 95 % CI 0·68–0·93 ; p=0·005 ) . Interpretation The reduction in neonatal mortality in intervention clusters occurred against a background of improvements in domiciliary practice s for maternal and newborn care . However , the poor reach of LHWs in accessing newborn infants at birth and in the early postnatal period underscores the limitations of tasking community health workers in public sector programmes working in similar circumstances with such complex interventions . Such community-based interventions in health systems should be accompanied by concerted efforts to improve quality of care in facilities and referral systems . Funding Saving Newborn Lives , Save the Children USA
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 .