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 .
Efficacy of in-service nutrition training for mid-level providers to improve feeding practices among HIV-positive children in Tanga, Tanzania: study protocol for a cluster randomized controlled trial
Background Feeding practice s and child undernutrition can be improved when trained health workers provide proper nutrition counseling to caregivers . However , this important management component is difficult to achieve in countries where trained health workers are limited ; Tanzania is no exception . In rural and semi-urban areas , mid-level providers ( MLPs ) are left to manage diseases such as HIV/AIDS.Training health workers in nutrition has been shown to be an effective intervention among HIV-negative children elsewhere , but no studies have been conducted among HIV-positive children . Furthermore , in Tanzania and other countries with MLPs , no evidence currently exists demonstrating an improvement in nutrition among children who receive health services given by MLPs . This study thus aims to examine the efficacy of nutrition training of MLPs on feeding practice s and the nutrition status of HIV-positive children in Tanga , Tanzania . Methods / Design We will conduct a cluster r and omized controlled trial in care and treatment centers ( CTCs ) in Tanga , Tanzania . The CTCs will be the unit of r and omization . We will select 16 CTCs out of 32 for this study , of which we will r and omly assign 8 to the intervention arm and 8 to the control arm by coin flipping . From the selected CTCs we will attempt to recruit a total of 800 HIV-positive children aged 6 months to 14 years , half of whom will be receiving care and /or treatment in the CTCs of the intervention arm , and the other half of whom will be receiving care and /or treatment in the CTCs of the control arm ( 400 children in each condition).We will provide nutrition training to MLPs of the CTCs selected for the intervention arm . In this intervention , we will use the World Health Organization guidelines on nutrition training of health workers for HIV-positive children aged 6 months to 14 years . The trained MLPs will then provide tailored nutrition counseling to caregivers of children being treated at the 8 CTCs of the intervention arm . We will measure nutrition status and child feeding practice s monthly for a total of six months . Conclusions Results of this trial will help exp and ing undernutrition interventions among HIV-positive children in Tanzania and other countries . Trial registration Current Controlled Trials : IS RCT N65346364
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 .