School children constitute ~20% of the population in Sri Lanka, making school health an important element in primary health care in this country. Sri Lanka faces severe economic problems, the challenge of reducing health inequalities within its society and a continuing ethnically based armed conflict. Historically, the school health program emphasised hygiene, screening for diseases and malnutrition and referrals to specialists. However, many interrelated factors influence the physical, mental and social health of school children. Schools should therefore provide not only a healthy physical setting, but also healthy social and emotional environments that promote better learning. This article uses both published and unpublished official documents, as well as a review of recent local research to present a comprehensive overview of school health programs in Sri Lanka, to identify problems with their content and implementation and to suggest ways for strengthening them. It is argued that there is a pressing need for a comprehensive national school health policy that not only addresses the essentials of planning and coordination, but also serves to reorient school health to embrace the promotion of physical and psychosocial health. Such a shift should be based on a whole-of-school approach, recognising the role of students, teachers and the wider community.