Barriers to Tuberculosis Case Detection in Ghana: A Multi-district Qualitative Analysis

Background Tuberculosis (TB) remains a leading cause of morbidity and mortality in sub-Saharan Africa, with Ghana detecting only 29–34% of estimated incident cases despite the availability of molecular diagnostics. Persistent gaps in case detection threaten national and global End TB targets. This study explored the programmatic, institutional, and healthcare worker factors influencing TB case detection in Ghana. Methods A qualitative study was conducted across five districts in Ghana: Agona West, Asuogyaman, Denkyembour, Ellembelle, and Krowor. Data was collected through 25 in-depth interviews and five focus group discussions of 8–10 participants with healthcare workers involved in TB prevention and control. Participants were recruited using purposive and snowball sampling. The data was transcribed verbatim and analyzed thematically with the aid of MAXQDA 2020. Results Four major programmatic gaps were identified: limited diagnostic resources, patient non-compliance and stigma, inadequate health education and training, and weaknesses in reporting and coordination. Institutional-level challenges included inadequate infrastructure, weak intersectoral collaboration, policy gaps, staff shortages, and high workloads. Healthcare worker–related barriers encompassed stigma, fear of infection, low motivation, and limited training and knowledge of TB screening protocols. These multi-level gaps collectively contributed to diagnostic delays, underreporting, and missed opportunities for early TB detection. Conclusions Persistent gaps in TB case detection in Ghana are driven by health system weaknesses, socio-cultural barriers, and inadequate workforce capacity. Strengthening decentralized diagnostic services, expanding training and supportive supervision, implementing stigma-reduction interventions, and improving coordination and surveillance systems are essential to accelerate progress toward Ghana’s TB control targets and the WHO End TB Strategy.