BACKGROUND:
Evidence shows performance management is an integral ingredient for health systems improvement. In primary healthcare (PHC), performance management enables decision makers to have visibility on PHC areas that are poorly performing and direct the needed actions and investments for improvement. The PHC PM project is institutionalizing these performance management processes at the county level in Kenya. Implementation Working with counties, we co-created a list of indicators that have been used to assess PHC performance at baseline and a shorter list that measures performance monthly. We co-formulated county core teams that consist of county health management team members who meet monthly to conduct root cause analysis on the identified PHC gaps and develop action plans that are implemented within the month. Co-created a PHC dashboard to help with decision making. Co-implemented peer learning workshops to enhance sharing of best practices between counties and PHC partners. Co-located offices within the county to enhance collaboration and garner political goodwill. Outcomes County core teams have implemented more than 75% of their action plans across five PHC performance domains leading to PHC improvements. The PHC dashboard is now being used to inform improvement actions. Project integration into the county health system has enhanced political goodwill and support for PHC investments and improvements.

CONCLUSIONS AND RECOMMENDATIONS:
Performance management at the county level has been integral to PHC improvements. Co-developing and co-implementing interventions with the county enhanced local ownership, political support and institutionalization. Other counties can adapt performance management as a tool towards PHC transformation.