In countries where Civil Registration and Vital Statistics systems (CRVS) are not fully established and developed, Health and Demographic Surveillance System (HDSS) play a significant role in capturing the health status of a population. This paper describes primary findings and explores the process involved in establishing the largest Maternal and Child Health Demographic Surveillance system (MCHDSS) in India. The present MCHDSS is established in Urban, Rural and Tribal settings in the State of Gujarat in 2019 by Indian Institute of Public Health, Gandhinagar. It covers 2 districts, 3 sub-districts/blocks, 132 villages, translated into 2,31,336 individuals. The population being surveyed and monitored largely belongs to marginalized and poor communities. MCHDSS employs a prospective longitudinal survey designed to study 1) Socio-economic situations, basic household level facilities (water, sanitation, etc.) and health, 2) Current situation and longitudinal changes in the Maternal and Child health and 3) provide a platform for testing innovations and interventions for improvement in maternal and child health indicators. Large MCHDSS such as this, will not only yield conventional health and demographic dataset, it will also provide a huge platform for the innovators to field test and proof their innovations in real-life situations. Apart from ensuring data quality, setting up of future HDSS should consider other identified challenges such as retention of human resources, technical difficulties that revolve around the mode of the digital survey and maintaining relations with stakeholders.