A STUDY ON OPERATIONAL EFFICIENCY OF OUTPATIENT DEPARTMENT SERVICES AT PRIMARY HEALTH CENTRES OF GUJARAT, INDIA: AN OBSERVER-BASED ASSESSMENT OF RESOURCES, PATIENT FLOW, QUALITY AND DIGITAL READINESS

Abstract

Background. Outpatient departments (OPDs) are the first point of contact between communities and Primary Health Centres (PHCs). Gujarat lacks facility-level evidence on how PHC OPDs are resourced, organised and digitally supported. We assessed resources, operational efficiency, quality and technology use in PHC OPDs across Gujarat. Methods. In July 2026, observers completed 100 structured OPD assessments at 100 PHCs in 25 talukas of eight districts. A 44-item instrument, rated on a five-point agreement scale, covered manpower, medicines, laboratory services, equipment and infrastructure, patient flow and waiting, service quality, referral coordination, overall efficiency and technology. We compared domain scores across districts with Kruskal-Wallis and Dunn tests (Holm-adjusted). We examined correlates of overall efficiency with OLS regression and HC3 robust errors. Results. Observers rated overall efficiency 3.66 of 5 (SD 0.57). Manpower (3.62), medicines (3.56) and patient flow (3.51) scored higher than laboratory services (3.43), referral coordination (3.31) and quality (3.07). Compliance with certification and quality standards scored lowest (2.60). Computers (67%) and internet (59%) were available in most OPDs, yet only 2% to 4% of observers reported digital use for OPD activity, and 79% reported no digital use on any of three use items. Even so, observers agreed that digitalization could improve flow (78%) and efficiency (76%). Efficiency differed sharply by district (p < 0.001): about 4.0 in Ahmedabad, Gandhinagar, Amreli and Mehsana, versus 3.1 to 3.4 in Porbandar, Chhota Udepur and Devbhumi Dwarka. Referral coordination (b = 0.38, 95% CI 0.22 to 0.54) and patient flow (b = 0.22, 95% CI 0.005 to 0.44) were independently associated with overall efficiency (R² = 0.74). Conclusions. Observers rated PHC OPDs moderately efficient. District performance was uneven, quality certification was weak, and PHCs used little of their available digital capacity. Priorities are district-targeted resource support, stronger referral coordination and patient-flow management, and activation of existing digital infrastructure.