Introduction Full implementation of Option B+ guidelines in line with the World Health Organisation’s recommendation could avert as many as 3 million AIDS-related deaths and 3.5 million new HIV infections by 2025. This study explored health providers’ perspectives on health systems barriers affecting the implementation of Option B+ at the health facility level in Ghana.

Method A total of 17 in-depth interviews and two focus groups were conducted with health providers providing (prevention of mother to child transmission (PMTCT) services at Greater Accra regional hospital between April and May 2016. The Health providers were interviewed to obtain their perspectives on barriers for delivering Option B+ services. Interviews were tape-recorded and analysed using a thematic framework approach.

Results The findings highlight health system barriers that hinder optimal implementation of Option B+ guidelines. These comprise: inadequate work space for the provision of PMTCT services; limited laboratory capacity (lack of certain equipment for results confirmation); inadequate staff; lack of transport (for follow ups on defaulters) and training to upgrade staff knowledge. The supply of antiretroviral drugs was however not seen to be a challenge in this study.

Conclusion There are still some health system gaps that need to be addressed and strengthened to improve initiation, adherence and retention of clients in Option B+ care. Tackling these specific challenges will contribute towards the elimination of mother to child transmission (MTCT) of HIV, and improve maternal and child health outcomes in Ghana and the world at large.