A Cross-Sectional Study of Input-Output Performance of Health Facilities Under LaQshya: Evidence from Western Gujarat, India

Abstract

Introduction: The Government of India has implemented LaQshya initiative to improve quality of intrapartum and postpartum care in public health facilities through structured quality improvement initiatives. Yet, empirical evidence on how preparedness at facility level affects outcomes in maternal service delivery is lacking in majority of districts in Gujarat. Objective: To measure the association between input preparedness and output performance indicators of the labour rooms in public health facilities implementing LaQshya in Rajkot district, Gujarat. Methods: A cross-sectional study (March–June 2022) in eight LaQshya-notified government facilities of Rajkot assessed input readiness using a checklist adapted from LaQshya standards. Domains included infrastructure, equipment, drugs, and human resources, summarized as composite input scores. Output measures covered deliveries, caesarean rates, PPH, breastfeeding initiation, patient satisfaction, and referral delays. Descriptive analysis and Spearman’s rank correlation examined associations between facility readiness and maternal health service outcomes. Results: Composite input scores in facilities ranged from 56.2% to 89.5%. There were statistically significant positive correlations between input scores and early initiation of breastfeeding (ρ = 0.72, p = 0.043) and delivery volume (ρ = 0.61, p = 0.05). Facilities with higher input scores consistently performed better in critical maternal health outcomes. Facilities with low input scores had evidence of delays in the referral process, low patient satisfaction rates, and gaps in availability of supplies. Conclusion: Facilities with stronger LaQshya input showed better maternal outcomes, especially breastfeeding and delivery volume. Strengthening inputs in facilities with poor score may reduce maternal morbidity and improve patient satisfaction significantly.