Grade repetition is a common educational practice in schools in Ghana and Africa, yet it is under researched. Using a qualitative  approach this paper draws from interviews with teachers and principals in select schools in Accra, Ghana, to better understand the factors and outcomes associated with grade repetition. Findings show how students with irregular attendance, from poorer families, that are overage, or that are working domestically in homes, are more likely to repeat a grade. Some successful approaches suggested by teachers in making grade repetition more effective include changes to teaching methods, classroom structure, and opportunities for student participation.