This year marks the 40th anniversary of the Alma-Ata Declaration, adopted at the International Conference on Primary Health Care in 1978. Building upon Sri Lanka’s policies of free access to government provided health care services since the 1930s, the country signed the Alma-Ata Declaration in the same year. Since then, Sri Lanka’s health system has served as a role model for successful implementation of PHC for a number of years. The question is however, whether it is possible to keep this position as a PHC role model among low- and middle-income countries. We highlighted here some of those challenges and the way forward.