Munar Wolfgang, Snilstveit Birte, Aranda Ligia Esther, Biswas Nilakshi, Baffour Theresa, Stevenson Jenniffer
Global Health, George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA.
Synthesis and Reviews, 3ie London, London, UK.
BMJ Glob Health. 2019 Aug 16;4(Suppl 8):e001451. doi: 10.1136/bmjgh-2019-001451. eCollection 2019.
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.
Systematic mapping of performance measurement and management research in LMICs from 2000 to mid-2018; literature searches of seven academic databases and institutional repositories of impact evaluations and systematic reviews. Using a combination of manual screening and machine learning, four reviewers appraised 38 088 titles and abstracts, and extracted metadata from 137 impact evaluations and 18 systematic reviews that met the inclusion criteria. The resulting visual representation of the evidence base was uploaded to a web-based platform.
Since 2000, the number of studies has increased; the first systematic reviews were completed in 2010. Two-thirds of the studies were conducted in sub-Saharan Africa and South Asia. Randomised controlled trials were the most frequently used study design. 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.
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. Future efforts at redesigning PHC systems need to be informed by evidence on the most effective approaches for using PMM strategies.
我们梳理了低收入和中等收入国家（LMICs）初级卫生保健（PHC）系统中绩效测量与管理（PMM）策略的现有证据。这些策略被广泛使用，但其有效性仍无定论。本证据差距图描述了现有研究及证据差距。
对2000年至2018年年中LMICs的绩效测量与管理研究进行系统梳理；检索七个学术数据库以及影响评估和系统评价的机构知识库。由四名评审员通过人工筛选和机器学习相结合的方式，评估了38088篇标题和摘要，并从137项影响评估和18项系统评价中提取了符合纳入标准的元数据。由此生成的证据库可视化展示被上传至一个基于网络的平台。
自2000年以来，研究数量有所增加；首批系统评价于2010年完成。三分之二的研究在撒哈拉以南非洲和南亚开展。随机对照试验是最常用的研究设计。证据集中在两种PMM策略：实施策略（在职培训、继续教育、监督）和基于绩效的融资。问责安排方面存在重大差距，尤其是审计和反馈的使用。研究最少的结果类型是意外影响、危害和社会公平。
证据集中在不太可能实现健康结果变革性变化的干预措施上。所发现的差距表明，常规使用的PMM策略在实施时对其效果缺乏足够了解。未来重新设计初级卫生保健系统的努力需要依据关于使用PMM策略最有效方法的证据。
