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 .
eRegQual—an electronic health registry with interactive checklists and clinical decision support for improving quality of antenatal care: study protocol for a cluster randomized trial
Background Health worker compliance with established best- practice clinical and public health guidelines may be enhanced by customized checklists of care and clinical decision support driven by point-of-care data entry into an electronic health registry . The public health system of Palestine is currently implementing a national electronic registry ( eRegistry ) for maternal and child health . This trial is embedded in the national implementation and aims to assess the effectiveness of the eRegistry ’s interactive checklists and clinical decision support , compared with the existing paper based records , on improving the quality of care for pregnant women . Methods This two-arm cluster r and omized controlled trial is conducted in the West Bank , Palestine , and includes 120 clusters ( primary healthcare clinics ) with an average annual enrollment of 60 pregnancies . The intervention tool is the eRegistry ’s interactive checklists and clinical decision support implemented within the District Health Information System 2 ( DHIS2 ) Tracker software , developed and customized for the Palestinian context . The primary outcomes reflect the processes of essential interventions , namely timely and appropriate screening and management of : 1 ) anemia in pregnancy ; 2 ) hypertension in pregnancy ; 3 ) abnormal fetal growth ; 4 ) and diabetes mellitus in pregnancy . The composite primary health outcome encompasses five conditions representing risk for the mother or baby that could have been detected or prevented by high- quality antenatal care : moderate or severe anemia at admission for labor ; severe hypertension at admission for labor ; malpresentation at delivery undetected during pregnancy ; small for gestational age baby at delivery undetected during pregnancy ; and large for gestational age baby at delivery . Primary analysis at the individual level taking the design effect of the clustering into account will be performed as intention-to-treat . Discussion This trial , embedded in the national implementation of the eRegistry in Palestine , allows the assessment of process and health outcomes in a large-scale pragmatic setting . Findings will inform the use of interactive checklists and clinical decision support driven by point-of-care data entry into an eRegistry as a health systems-strengthening approach . Trial registration IS RCT N trial registration number , IS RCT N18008445 . Registered on 6 April 2017
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 .