African swine fever is a highly contagious and deadly disease of both domestic and wild pigs. In developing countries such as Ghana, the diagnosis and control of ASF are very challenging. In this paper, we discussed factors that account for ASF endemicity in many developing nations, with special focus on Ghana. We identified possible ASF spread via pig value chain through the transportation of live pigs across regions in Ghana. Major factors contributing to ASF spread in Ghana include lack of farmer compensation during ASF outbreaks, free range system of pig farming, porous country borders, lack of rapid on-site diagnostic test kits, unsafe sample collection and transportation to diagnostic laboratories, long diagnostic test turnaround, and improper carcass disposal. We also discuss available diagnostic options for ASF and their limitations. We propose a more holistic approach to ASF control in Ghana. These measures include applying a muti-sectoral approach, rehabilitation of inactive regional laboratories and expansion of services to six newly established regions, promoting point of care testing and developing and implementing farmer compensation plan during outbreaks. These proposed ASF control measures will provide field veterinarians with effective means to make informed decisions while awaiting laboratory confirmation of outbreaks.