The study examines the integration of sustainability considerations into the implementation of Output and Performance-Based Road Contracts (OPBRCs) in Ghana and draws lessons for emerging economies. Using a qualitative case study approach, the research analyses documentary evidence from Ghana’s Transport Sector Improvement Project (TSIP), particularly the Project Completion Report and the World Bank Implementation Completion and Results Report, through a thematic sustainability integration framework. The findings show that sustainability was embedded in OPBRC implementation through policy alignment, multiyear maintenance obligations, environmental and social safeguards, grievance redress systems, road safety provisions, road asset management systems, and performance monitoring arrangements. However, the integration was uneven and often constrained by limited institutional capacity, unstable financing, incomplete operationalisation of data and asset management systems, procurement and design delays, weak occupational health and safety compliance, and uncertainty surrounding post-project maintenance financing. The Ghana case, therefore, demonstrates that OPBRC may better support sustainable road asset management in comparison with traditional contracting, however only when supported by strong governance, institutional readiness, reliable financing, and effective monitoring. The study contributes to the literature by reframing OPBRC implementation through a sustainability integration lens rather than viewing it only in terms of implementation barriers.