Despite significant progress in access to parasite-based diagnosis over the past decade, a large gap persists. Addressing the gap will require a coordinated mix of technological, logistical, health system and financial solutions. New threats to current tools such as pfhrp2 gene deletions highlight the need for improvements of existing tests and for innovation. Studies measuring the impact of using more sensitive diagnostic tools as part of a range of interventions targeting elimination settings, post elimination/prevention of reintroduction and pregnant women, will be essential to inform use and future product specifications.