This study provides an overview of Ghana’s use of Output and Performance Based Road Contracts under the Transport Sector Improvement Project. Although these contracts are widely used globally, there is limited evidence on how they perform in Sub Saharan Africa, especially in first time implementation contexts. This creates a gap in understanding whether such contracts can work effectively in countries with limited institutional capacity and unstable economic conditions. The study adopts a qualitative documentary case study approach using five official reports from the World Bank and Government of Ghana covering the period from 2017 to 2026. Data were analysed across key areas such as contract design, engineering performance, economic outcomes, and implementation challenges to provide a complete picture of Ghana’s experience. The findings show that the contracts achieved strong results in terms of road quality improvement, reduced travel time, increased traffic, and positive economic returns. However, several major challenges were identified, including long procurement delays, contractor capacity gaps, funding difficulties due to economic instability, and safety concerns during project implementation.  The study recommends that future projects should ensure stable and protected funding arrangements before implementing performance based contracts, since consistent payment is critical for their success.