<p>The Himalayan region of India, characterized by its rugged terrain and dispersed population, faces unique challenges in delivering equitable and accessible healthcare services. Despite numerous government initiatives, substantial gaps persist in the distribution and quality of health infrastructure across the Himalayan states. This study investigates these disparities using secondary data from various published sources. We employed Principal Component Analysis (PCA) to develop a Composite Health Infrastructure Index (CHII), ranking the states based on their health infrastructure for the year 2021–22. The rationale behind the study lies in the urgent need to understand and quantify regional inequalities in health infrastructure, which are often masked by national averages. The findings reveal significant discrepancies, with Jammu and Kashmir exhibiting the most advanced infrastructure, while Sikkim ranks the lowest, its CHII being 20 times lower than that of Jammu and Kashmir. A regional comparison indicates that the northern Himalayan states generally outperform their northeastern counterparts, except Assam. Key factors contributing to these disparities include the number of hospital beds per 1,000 population, health facilities per 100,000 population, health professionals per 100,000 population, and overall health expenditure per capita. From a policy perspective, it is crucial to address the structural and logistical barriers that hinder the development of comprehensive and inclusive health infrastructure in the Himalayan region.</p>