<p>Ghana’s labour market exhibits a persistent paradox: tertiary education has expanded, yet youth unemployment remains high, and micro, small, and medium enterprises (MSMEs) continue to report shortages of work-ready labour. This study analyses the structural, institutional, and socio-cultural drivers of graduate unemployment and MSME labour deficits in Ghana and proposes a policy framework for better aligning education outputs with labour-market demand. The study adopts a conceptual-empirical design. It integrates human capital theory, signalling theory, structural transformation perspectives, and TVET/competency-based training literature with secondary analysis of official labour statistics, policy documents, and peer-reviewed studies. The analysis is descriptive and integrative rather than causal, using triangulation across sources to explain mechanisms shaping Ghana’s school-to-work transition. The analysis shows that graduate unemployment in Ghana reflects both weak labour absorption and education-to-work mismatches. High youth unemployment and NEET rates coexist with evidence of skills and qualification mismatches among employed persons. Prestige bias toward academic credentials, weak university-industry linkages, limited work-integrated learning, deficits in applied digital and soft skills, and wait-unemployment dynamics collectively weaken graduate employability and MSME labour absorption. Ghana’s graduate employment challenge is structural rather than transitional. Addressing it requires coordinated reforms centred on competency-based training across tertiary education, institutionalised university-industry collaboration, MSME-targeted training and hiring incentives, and labour-market-informed career guidance. Such reforms must link educational expansion to verifiable competencies and productive labour demand if Ghana is to convert its youth population into inclusive economic development.</p>