Structural Barriers and Policy Gaps in Breast Cancer Care Delivery in Ghana: A Focused Ethnographic Inquiry

Background: Inequalities in breast cancer care remain a major challenge in low- and middle-income countries. In Ghana, women continue to experience barriers that limit timely diagnosis, treatment, and continuity of care. This study explored the structural, health system, and policy factors influencing breast cancer care inequalities in Ghana. Methods: A focused ethnographic study was conducted across five healthcare facilities in Ghana between February 2023 and February 2024. Data were collected from 95 participants through in-depth interviews, observations, field notes, and document reviews and analysed thematically using Spradley’s ethnographic analytical framework. Results: Breast cancer care inequalities were driven by interconnected financial, health system, and governance barriers. Participants reported high out-of-pocket costs, inadequate financial protection, diagnostic and workforce shortages, centralised oncology services, fragmented referral pathways, and limited care coordination. Weak policy implementation, procurement challenges, and inconsistent availability of essential cancer medicines further constrained equitable access to care. Conclusions: Breast cancer care inequalities in Ghana are rooted in systemic weaknesses in financing, service delivery, and governance. Strengthening financial protection, decentralising oncology services, improving diagnostic capacity, enhancing care coordination, and ensuring reliable access to essential medicines are critical to achieving equitable breast cancer care.