INTRODUCTION:
Female Genital Schistosomiasis (FGS) remains severely overlooked within neglected tropical diseases (NTD), disproportionately affecting women in sub-Saharan Africa. Despite its high prevalence and association with adverse reproductive health outcomes and increased HIV susceptibility, FGS receives minimal attention in policy and clinical practice. Understanding how FGS is or isn’t prioritised within policy implementation is critical to addressing this gap. Therefore, this paper examines how FGS is understood, prioritised, and addressed within South Africa’s Health Department’s NTD Master Plan implementation across different levels within the health system.

METHODS:
We employed a qualitative approach guided by Institutional Ethnography and Lipsky’s Street-Level Bureaucracy to map the institutional relations shaping NTD activities, and understand how frontline discretion influences the prioritization of FGS, respectively. Thirteen semi-structured interviews were conducted with stakeholders at the national, provincial, district, and facility levels, complemented with non-participant observation carried out during a Communicable Disease Control stakeholder meeting. A hybrid (deductive–inductive) approach to thematic analysis was used to examine how policy texts, governance structures, and everyday implementation practices collectively contribute to the marginal positioning of FGS within the NTD Master Plan. Preliminary Results While the National and provincial levels of government demonstrate awareness of FGS and expressed concern regarding its clinical and public health implications, knowledge at district and health facility levels was limited, with some reporting little to no familiarity with the disease. Some participants perceived FGS to be included within the NTD Master Plan; however, this inclusion was described as limited and lacked operational clarity, particularly in the absence of finalised policy.

CONCLUSIONS:
Uneven knowledge limited institutional ownership, and structural constraints at the point of service delivery undermine the translation of policy recognition into practice. Strengthening the integration of FGS into NTD and sexual and reproductive health programmes may be critical for addressing neglect and advancing equitable NTD responses.