India's hospital disaster preparedness remains constrained by fragmented governance, where the Disaster Management Act 2005 mandates plan without enforcement mechanisms, NDMA Hospital Safety Guidelines 2016 specify structural and functional standards absent routine audits, and NABH accreditation standards probe quality without systematic integration—collectively limiting advancement of the Sendai Framework's. This gap undermines health system resilience in a multi-hazard nation where ~25% of hospitals become non-functional post-disaster. This quantitative cross-sectional study, conducted June 2017–May 2018 across six North Indian states, addresses this novelty by assessing framework integration in 10 accredited hospitals involving 609 hierarchically stratified respondents. Hazard-prone Uttarakhand/Himachal Pradesh achieved superior procedural preparedness versus low-risk Uttar Pradesh/Delhi, revealing hazard-driven institutional culture trumping resources. Aggregate KAP scores showed moderate knowledge but strong attitudes and practice gaps, with females/postgraduates excelling. Critically, NABH with explicit DM/NDMA integration correlated with 20–30% higher outcomes across dimensions, confirming governance convergence effects absent in siloed facilities. The study thrusts on embedding NDMA/DM provisions into NABH audits via a proposed conceptual Unified Hospital Disaster Preparedness Framework (UHDPF) which offers a scalable mechanism to operationalize Sendai priorities nationwide, institutionalizing resilience. Barriers include costs and gaming risks, addressable through independent verification; piloting required for validation.
Yadav et al. (Mon,) studied this question.