Natural Language Processing (NLP) for Ghana's 73 living indigenous languages remains deeply fragmented, under-resourced, and heavily skewed toward a single language. We present the first systematic review of the Ghanaian NLP landscape, screening 17,000+ publications across four academic databases to critically synthesize 36 core studies spanning datasets, model architectures, and evaluation paradigms. Our analysis exposes a severe resource imbalance: Twi-centric NLP has grown modestly, driven largely by religious-text alignment and crowdsourcing, while the remaining 70+ languages remain almost entirely unaddressed, and dataset releases, model checkpoints, and evaluation practices remain inconsistent and rarely shared across the field. We translate these findings into a prioritized roadmap targeting Ghana's acute regional constraints, dialectal variation, non-standardized orthographies, and the absence of shared infrastructure, offering a replicable template for systematic review and research prioritization in other low-resource language settings.

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