Malagasy challenges and opportunities for the implementation of guidelines recommendations
| Strengths | Weaknesses | Opportunities | Threats | |
| Rec 1–3 | Updated prevalence data; Pilot MDA in adult population already ongoing (two districts in 2021) | Shortage of human resources and domestic funding; Increased number of districts involved in MDAs | Integration with other national programmes (CCDS and PNDE); Alternative strategies already ongoing (community, door-to-door) | Low schooling rate; PZQ mandatory administration with food; Seasonality implication for biannually MDA planning; Interruption of MDA in IDPs |
| Rec 4 | Inter-district redistribution of drugs already ongoing | Elevated expected needs for drugs and testing | Strengthen lab and medical capacity | Jeopardised implementation due to inaccessibility of PHC |
| Rec 5 | Possibility to assess alternative one-health approach in different ecosystems | Need for ecological survey before interventions (costs) | Benefit of WASH interventions for other diseases; Integration of sanitation with the PADRC national programme | Potential threat for biodiversity |
| Rec 6 | No need for animal assessment (S mansoni and S haematobium only) | Unlikely to be applied in early future given the overall high prevalence | Reinforcement of laboratory coordination in a one-health approach | Reporting and monitoring weakness of MDA programme |
CCDS, Comité Communale de Développement Sanitaire; IDPs, Internally Displaced Populations; MDA, mass drug administration; PADRC, Programme appui à la Décentralisation et à la Résilience Communautaire; PHC, Primary Health Care; PNDE, Plan National pour la Decentralisation Émergente; PZQ, Praziquantel; WASH, WAter Sanitation and Hygiene.