India’s COVID-19 battle will be told and retold in the coming years, inspiring both praise for what the country has achieved, and critique for its shortfalls. As India’s story continues to unfold, two strands will mould the various assessments. First is India’s aggregate performance as a developing economy: It marshalled its meagre resources to respond to the exponential threat of the virus, and was determined, too, to be part of global solutions to this scourge, such as the manufacture and supply of life-saving vaccines. The second, and perhaps even more important story is on ground-zero: In its cities and villages, India’s success or failure would be a factor of the leadership and stewardship of Prime Minister Narendra Modi and his team in responding to the crisis, and the commitment of the chief ministers and state functionaries to beef up their health systems and save lives.

Whichever way the India story is told, there are certain truths that cannot be hidden: We need to invest more in our health systems, and acknowledge the stellar role of our frontline workers and formal and informal health sector personnel, as well as India’s prowess in certain segments of the medical and health industry.

In this context, it becomes interesting to see how in the country’s federal structure (where health is a State subject), the sub-national units—i.e., states and union territories (UTs)—have performed. The present work, Health Systems Resilience Index: A Sub-National Analysis of India’s COVID-19 Response, provides answers to that question. It builds on an earlier report published by the Observer Research Foundation in May 2020. That report, State of the States: Two Months of the Pandemic, evaluated India’s initial response to the pandemic shortly after the crisis was officially named by the World Health Organization (WHO). Two years since then, this report attempts a more ambitious goal: to devise a unique Resilience Index for the health systems of India’s states and UTs.