Social development trends are invariably linked to achieving the Sustainable Development Goals (SDGs) by 2030. However, the SGDs will most likely not be achieved as expected in Asia and the Pacific, a region that faces many challenges, including rapid population ageing. Sri Lanka, hailed for its robust public health system at a relatively low cost, is one of the countries in the region experiencing rapid population ageing that needs urgent reform to ensure all people have access to affordable and good quality healthcare. This paper explores the current situation, and ways forward to strengthen health systems in Sri Lanka in the context of population ageing, climate change, disaster preparedness and investing in technology solutions for health. The analysis in the paper shows that, despite having a robust public health system and having achieved universal healthcare coverage long before many other countries, the Sri Lankan health system is only partially prepared to face the challenges ahead with regard to population ageing, climate change and technological advancements. While political intentions and policy formulation to prepare for the next few decades are evident to some extent, realization of such intentions at the ground level shows many gaps and lapses in the implementation process. Coherent policy support across all sectors and intersectoral coordination of implementation plans are much needed for a more comprehensive, equitable and sustainable future of the country’s health system, especially considering rapid population ageing. Climate change impacts on all aspects of life are increasingly evident in Sri Lanka, as in other countries. These have unequal and profound effects on vulnerable segments of the community, emphasizing the need for ensuring gender and social inclusion in disaster risk reduction planning. It is also evident that, while the current health system is catering to requirements of the overall population to a large extent, many people, including older persons, have special service requirements that warrant urgent attention. Declining fertility and reversing the rise in the dependency ratio by having an older workforce, raise new challenges in maintaining or increasing productivity on the economic front. Anticipated changes in the labour market and increasing the retirement age call for new policies and legislation to protect older workers’ rights. On a positive note, rapid development in the telecommunication sector during the last two decades has provided a strong foundation for the country to transform itself into a digital economy and utilize technology-based solutions to enhance health systems. This paper proposes several recommendations to strengthen the health system to overcome the observed challenges, with particular attention to enhancing the health and well-being of older persons in the context of population ageing.