From Accra to America: Lessons from Ghana's Health Access Systems to Advance Equity and Affordability in U.S. Oncology Care

Affordability, quality, and accessibility to high quality oncology care in the United States is disproportionate with respect to cost barriers, fragmented funding and geographic differences. Ghana can be used to provide insights into the development of access in the environment of limited resources, by reforming health financing, task-shifting, and community-based service delivery. This paper uses the Ghana health access systems to learn how oncology care in the U.S can be scaled and equity-based, using lessons learned in Ghana. Comparative policy analysis using a mixed method was done. Phase 1 included a systematic scoping review (2000-2025) of Ghanaian policies, program evaluation and grey literature on health insurance (NHIS), community-based primary care (CHPS) and cancer screening programs. Phase 2 involved key informant interviews on 25 stakeholders, including policy makers, oncologists and community health workers in Ghana and the U.S, and thematically analyzed them to extract success mechanisms. Phase 3 simulated the cost-effectiveness and cost implication of three modified Ghana-based interventions, including: (a) community-based screening and patient navigation, (b) nurse-led oncology care through task-sharing, and (c) tiered co-payment waivers with specific subsidies. The results indicate that Ghanaian strategies encourage diagnosis at an early stage, less out-of-pocket payments, and primary-specialty care connections. It has been projected using simulations that changing the community screening and task-sharing within the U.S. safety-net environment will reduce cases of late-stage cancer and the costs associated with treatment. Nonetheless, payment reform, investing in the workforce and supportive regulation will be required to implement this.