Poor community awareness and inconsistent laboratory testing for leptospirosis means cases go undiagnosed. Leptospirosis can be mistaken for the flu and half of sufferers experience debilitating symptoms over months. This disease burden falls heavily on rural and Māori communities. While good treatment and prevention methods are available, low rates of awareness and diagnosis exacerbate existing inequities in health outcomes. We will inform policy, systems, and practice changes in health delivery by working with iwi, DHBs and communities to (1) increase awareness of the symptoms and effects of Leptospirosis, (2) improve testing that will not only enable greater access to diagnosis, but provide sequencing information on incidences that can provide evidential basis for changes, and (3) determine the true incidence of disease in a rural case study site by investigating febrile patients and healthy whānau in at-risk occupations.