Bangladesh has made significant progress in public health, including reductions in maternal and child mortality and increased immunization coverage. However, the health system faces growing challenges due to population ageing, urbanization, non-communicable diseases, climate change, and ongoing inequities in access and funding. These challenges are particularly pronounced for older persons, women and socioeconomically marginalized populations, who experience compounded vulnerabilities across the life course. This paper aims to examine these emerging issues and their effects on health system performance, while identifying strategic policy priorities to enhance resilience, equity and efficiency. A specific focus is placed on the implications of rapid population ageing and gendered health inequalities for service delivery, financial protection and long-term care. The analysis is based on a structured review of publicly-available literature, including peer-reviewed studies, government policy documents and reports from international agencies. Findings reveal systemic gaps in governance, health financing, human resources, infrastructure, service delivery and information systems, which are exacerbated by climate- and disaster-related vulnerabilities. These systemic weaknesses disproportionately affect older persons, particularly older women, through elevated out-of-pocket expenditures, limited access to age-responsive services and heavy reliance on informal care. Despite innovations – such as community clinics, health financing pilots and digital health initiatives – progress remains uneven. The paper provides evidence-based policy recommendations to promote universal health coverage and build a more responsive, inclusive and sustainable health system, with explicit attention to healthy ageing, gender equity and a reduction of social and geographic health disparities.