Quality of Maternal and Child Health Services in Outpatient Departments of Primary Health Centres Using National Quality Assurance Standards: A Cross-sectional Study in Bhavnagar District, Gujarat

Abstract Introduction: Maternal and child health remains a priority in India and Primary Health Centres (PHCs) are the first point of care for antenatal and child health services. However, outpatient service quality remains variable, underscoring the need for systematic quality assessment to identify gaps and guide improvement. Objective: The objective of this study is to assess the quality of maternal and child health services delivered in PHC outpatient departments in Bhavnagar district using the National Quality Assurance Standards (NQAS) tool and to identify key gaps. Methods: A cross-sectional study was conducted in all 46 functional PHCs of Bhavnagar district, Gujarat, from September 2023 to November 2025. Outpatient services were assessed using the NQAS checklist across eight domains through observation, interviews and record review. Each checkpoint was scored from 0 to 2. Data were analysed using Epi Info 7.0 and presented as proportions and percentage scores. Scores of ≥70%, 36%–69% and ≤35% were classified as good, fair and poor, respectively. Results: Of 46 PHCs, 12 (26.08%) were rated good, 29 (63.04%) fair and 5 (10.86%) poor. Service provision and clinical care scored the highest, whereas quality management and outcomes were the weakest. Functional antenatal clinics were available in 76.09% PHCs and essential medicines in 93.48%. Updated Standard Operating Procedures (SOPs) were available in only 4.35%, with inadequate antenatal consultation time in 82.61%. Conclusions: Half of the PHCs achieved good quality scores, but important gaps persisted in quality management, SOPs, and antenatal consultation time.