Political prioritization of prevention of mother-to-child transmission of HIV and syphilis: a qualitative comparative policy analysis in Ghana, Mozambique, and Sudan

Background: Despite global commitments to eliminate mother-to-child transmission of HIV and syphilis, political and resource prioritization remains uneven across low- and middle-income countries. This has led to disparities in financial investment, policy implementation, and health outcomes. This study examines the factors shaping political prioritization of prevention of mother-to-child transmission (PMTCT) in Ghana, Mozambique, and Sudan using the Shiffman and Smith framework to understand how political, institutional, and contextual forces interact to influence national responses. Methods: A qualitative, cross-country comparative policy analysis was conducted based on document review from 3 data sources. Across countries, we included 21 government documents, 22 documents from non-governmental organizations, and 15 peer-reviewed articles selected through theoretical sampling. Both inductive and deductive thematic analyses were applied, with the latter guided by the Shiffman and Smith framework. Findings: Political prioritization of PMTCT was influenced by interrelated domains including actor power, ideas, political context, information systems, and financial resources. Ghana and Mozambique achieved higher prioritization through cohesive advocacy networks, effective issue framing, strong political commitment, reliable data, and sustained donor support. In contrast, Sudan's limited progress reflected low political commitment due to fragmented leadership, weak coordination, inadequate data, and chronic resource constraints. The findings illustrate that progress depends not only on individual determinants but also on their interaction within national policy systems. Conclusion: Political prioritization of PMTCT results from the interaction of multiple interlinked factors rather than any single determinant. Strong advocacy, effective framing, reliable data, and sustained funding within supportive political environments foster commitment, as seen in Ghana and Mozambique. Coordinated advocacy, credible evidence, and predictable investment are essential to strengthen the PMTCT program by translating the global elimination goals into actionable national strategies.