Leishmaniasis remains a significant public health burden in many tropical and subtropical regions, particularly among impoverished and marginalized communities. This chapter focuses on promoting equitable and sustainable treatment models that address the underlying socioeconomic and structural barriers limiting access to effective care. The disease's epidemiology reveals high incidence in parts of Asia, Africa, South America, and the Mediterranean region, with climate change and migration contributing to new and emerging hotspots. Populations at greatest risk include low-income groups, displaced individuals, and children. Barriers to treatment are multifaceted, encompassing high costs, limited proximity to healthcare facilities, weak health infrastructure, and social stigma particularly for women with disfiguring cutaneous lesions. Current therapies (such as pentavalent antimonials, liposomal amphotericin B, miltefosine, and paromomycin) face limitations including drug resistance, high toxicity, poor patient adherence, and limited pediatric formulations. Many treatment programs are donor-dependent, with little national production capacity or local drug supply chains, making them unsustainable. Promising models include community-based interventions, mobile clinics, integration into primary healthcare, and the use of culturally appropriate health education. Innovations in treatment (such as low-toxicity oral therapies, nanotechnology-based delivery systems, digital surveillance tools, and vaccine development) offer new hope for sustainable care. Policy approaches that emphasize local ownership, international collaboration, and regulatory support for access to essential drugs are critical. Case studies from India, Brazil, and Sudan demonstrate both progress and persistent challenges in implementation. The chapter concludes by emphasizing the need for inclusive, data-driven strategies that empower communities, strengthen health systems, and promote long-term, equitable treatment for leishmaniasis.