CAG flags gaps in disaster preparedness in State hospitals

An audit by the Comptroller and Auditor General (CAG) of India has flagged serious shortcomings in disaster management preparedness across hospitals in Karnataka, including the absence of evacuation plans, fire safety mechanisms, and mandatory statutory clearances.

The CAG report, tabled in the Legislature during the Belagavi session, examined the performance of public health infrastructure and management of health services, including disaster management, for the period 2016 to 2022.

As per the National Health Mission (NHM) assessor’s guidebook, every health institution (HI) is required to have a disaster management plan (DMP), standard operating procedures for disaster response and a disaster management committee to periodically review preparedness. However, the audit found uneven compliance among the test-checked institutions.

Of the 29 health institutions audited up to the community health centre (CHC) level, 23 had prepared disaster management plans and 20 had constituted disaster management committees. However, except for Victoria Hospital in Bengaluru, none of the test-checked institutions had evacuation plans in place for emergencies.

The audit also noted partial compliance with basic safety requirements. While 26 institutions had displayed fluorescent fire exit signage, only six had displayed important emergency contact numbers of nearby medical centres, blood banks, fire, police and ambulance services.

Fire safety concerns

More serious deficiencies were observed in fire prevention and firefighting preparedness. Under the Indian Public Health Standards (IPHS) guidelines, hospitals are required to have fire hydrants, sand buckets and underground water facilities, and to obtain no-objection certificates (NOC) from the Fire Department.

The audit found that none of the test-checked institutions, except KIMS, Hubballi, and Victoria Hospital, had fire hydrants. Two institutions - taluk hospital at K.R. Puram and  CHC at Sargur - had no firefighting mechanism at all. Though 40 institutions had fire extinguishers, in 15 of them the equipment had not been refilled after expiry. Except for five institutions, none had obtained NOCs from the Fire Department.

Further, smoke detectors and alarms were absent in 41 health institutions, and a fire prevention plan was available in only 11 facilities. The absence of firefighting mechanisms  would make evacuation of patients and staff extremely difficult in the event of a fire, the audit report warned.

Gaps being addressed

Indira Kabade, nodal officer for disaster management in the Health Department, said the gaps identified by the audit were being addressed at the institutional level. She pointed out that the audit covered the period from 2016 to 2022, including the COVID-19 years, and that significant upgrading of hospital infrastructure had taken place after the pandemic. “We are continuously monitoring compliance, and the Health Commissioner has issued a circular last month,” she said.

According to the Health Commissioner’s circular dated November 11, 2025, all health institutions across the State - including district hospitals, taluk hospitals, CHCs and primary health centres (PHCs) -  have designated their respective heads as nodal officers for disaster management. Medical officers, administrative medical officers, district surgeons, medical superintendents and heads of institutions have been directed to strictly adhere to the National Disaster Management Guidelines for Hospital Safety.

The circular prioritises compliance with five key requirements highlighted in the CAG report: preparation of disaster management plans, constitution of disaster management committees, formulation of evacuation plans, installation of fire exit signage and display of 

Instructing heads of health institutions to ensure compliance, the Circular stated that District Health and Family Welfare Officers will compile compliance reports and submit consolidated reports to Divisional Joint Directors for verification. Following this, verified reports must be forwarded within 15 days to the Disaster Management Nodal Officer at the Health Commissionerate, the circular added.

EOM/