This study provides useful information and insights on strengthening the public health infrastructure of Maharashtra, the largest state economy, second most populous, and third most urbanized state in India. The COVID-19 pandemic has highlighted the importance of strong and resilient health systems for sustainable development. The national health system in India is the conglomeration of state health systems operates within the country’s federal structure. Although focusing on Maharashtra, this study presents a state health system assessment and sources of information that may also be useful to other states in India.