Assessing Health Equity in National Cancer Control: A Systematic Review of Cervical and Breast Cancer Services in Ghana

**Revised Abstract**

Persistent inequities in cancer outcomes across Africa underscore the need to critically evaluate the implementation of National Cancer Control Plans (NCCPs). This systematic review conducts a health equity audit of Ghana’s NCCP, focusing on cervical and breast cancer services. Its objective is to synthesise evidence on equity in service delivery, access, and outcomes to identify implementation gaps and inform policy. Adhering to PRISMA guidelines, a reproducible search strategy was executed across PubMed, Scopus, African Journals Online, and relevant grey literature sources for studies published between January 2010 and March 2024. Following a screening process against pre-defined eligibility criteria, data from included studies were extracted and synthesised thematically.

The findings reveal pronounced geographical and socioeconomic disparities. A consistent urban–rural divide is evident, with screening, diagnostic, and treatment facilities concentrated in southern urban centres, disadvantaging rural populations. Key access barriers include substantial geographical distance, catastrophic out-of-pocket expenditures, and entrenched sociocultural factors, which disproportionately affect rural and low-income women. Although the NCCP articulates equity goals, a significant implementation gap persists, particularly in community-based awareness programmes and the integration of services within primary care.

The study concludes that realising equitable cancer control in Ghana requires a deliberate reorientation of strategies towards pro-poor, geographically targeted interventions and strengthened health system governance. These findings emphasise to policymakers across the region the necessity of embedding robust, monitorable equity audits within NCCPs to ensure they translate into tangible benefits for all population subgroups.