Achieving the Sustainable Development Goals (SDGs) requires the empowerment of learners through Education for Sustainable Development (ESD), already at primary level. Teacher education for the SDGs is a focus of ESD. However, many teachers in Madagascar are underqualified and show knowledge gaps regarding ESD. This paper aims at identifying starting points for an ESD-oriented further development of teacher training, considering regionally relevant issues. Teaching Sustainable Development issues requires procedural knowledge. This paper reports on (i) Malagasy primary school teachers’ (n = 286) teaching and learning prerequisites regarding land-use and health issues compared to expert knowledge, (ii) modeling teachers’ respective procedural knowledge with the Rasch Partial Credit Model and validation studies, and on (iii) comparison of groups of teachers differentiated by diversity dimensions, e.g., teaching at rural or urban schools. The teachers underestimated land-use and health courses of action regarding effectiveness and possibility of implementation, compared to experts. IRT modeling resulted in two distinct knowledge dimensions, i.e., land use and health (latent correlation: 0.31). Rural teachers showed higher procedural land-use knowledge than urban teachers. No differences occurred regarding health knowledge. The paper argues for ESD-focused reorientation of teacher training, considering regional specificities of land-use topics, e.g., regarding vanilla and rice cultivation in North-East Madagascar, and health topics.