Leprosy is still an important global health concern in many developing countries and it causes disability in 2 million people worldwide. In Malaysia as a country, the elimination status which was defined by World Health Organisation as attaining a level of prevalence below one case per 10,000 populations was achieved in 1994 and in the state of Sarawak it was achieved in 1996. However, leprosy is still highly prevalent among the minority indigenous Penans in Sarawak with an ethnic specific annual prevalence rate of 5.5 per 10,000 population compared to 0.07 per 10,000 population for the rest of the population in Sarawak from the year 2000 to 2013. This study aims to provide an overview of the prevalence of leprosy among the different ethnic groups in Sarawak, sharing findings from the active case detection activity in a Penan settlement in Sarawak and challenges in leprosy management among the minority indigenous Penans in Sarawak.