She is the daughter of Kofi Abrefa Busia, who was prime minister of the Republic of Ghana (from 1969 to 1972)[3] and a prince of the royal family of Wenchi,[4] a subgroup of the Ashanti, making Akosua a princess too.

[7] Busia grew up in Ghana, and began her acting career at the age of 16, attending London's Central School of Speech and Drama on scholarship.

After moving to Los Angeles in the early 1980s, she was cast to play a supporting role in the slasher film The Final Terror, directed by Andrew Davis (The Fugitive).

[9] Busia played Nettie, the younger sister of Whoopi Goldberg's character Celie Harris, in Steven Spielberg's 1985 The Color Purple,[10] adapted from Alice Walker's novel of the same title, as Ruth in Badge of the Assassin (1985), as Jewel in John Singleton's Rosewood (1997),[11] and as Patience in Antoine Fuqua's Tears of the Sun (2003).

[18] After 18-year hiatus to raise her daughter, in 2016 Busia returned to acting in the off-Broadway and Broadway production of Danai Gurira's play Eclipsed, alongside Lupita Nyong'o.