Education for Sustainable Development (ESD) plays a key role in Sustainable Development. In low-income countries like Madagascar, this key role is particularly relevant to primary education. However, the curricula lack a comprehensive ESD approach that incorporates regional issues. In Madagascar, sustainable land-use practices (Sustainable Development Goals 12, 15) and health prevention (SDGs 2, 3, 6) are educational challenges. Procedural knowledge allows problem-solving regarding unsustainable developments. We adapted and further developed a measure of ESD-relevant procedural knowledge. Considering curricula, sustainability standards, research, and a two-round Delphi study (n = 34 experts), we identified regionally relevant land-use practices and health-protective behavior. After the experts rated the effectiveness and possibility of implementation of courses of actions, we calculated an index of what to teach under given Malagasy (regional) conditions. Combined with qualitative expert comments, the study offers insights into expert views on land-use and health topics: For example, when teaching ESD in Northeast Madagascar, sustainable management of cultivation and soil is suitable, particularly when linked to vanilla production. Health-protective behavior is ultimately more difficult to implement in rural than in urban areas. These results are important for further curricula development, for ESD during primary education, and because they give insights into the topics teacher education should address.