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Institutional repositories have emerged as a reliable platform for showcasing intellectual outputs of academic institutions due to their inherent benefits. Despite the embrace of this concept, issues of their sustainability have come up as a result of the attrition of some repositories, especially in developing countries giving rise to the call to ascertain the significant issues regarding how repositories are set up and managed in the Ghanaian context. This study, using the comparative case study design, guided by the Diffusion of Innovations Theory, assesses how institutional repositories are created and sustainably managed for use by the academic communities of two private and two public universities in Ghana. It gathers data 37 respondents whose activities cover the operations of these repositories through semi-structured interview of respondents as well as observation of repository policy documents and the websites hosting the repositories. The thematically-analyzed data reveals that even though some academic institutions in Ghana have seen the worth of online digital institutional repositories in advancing scholarly communication; and have therefore developed same for this purpose, the needed involvement of key personalities on campus to create a wider acceptance of the concept by the general university community is missing. There are instances of repository development without sound policy frameworks. These lead to low material submission and low content access rate. The study thus recommends active and continuous engagement of the various interest groups within academic institutions in the management of the repositories to bring about an appreciable level of buy-in as well as the institution or strengthening of repository policies to address peculiar issues of the academic environment. Again, education on copyright issues should be offered to lecturers and other content producers in order to allow for material submission without infringing on any copyright laws. This should be done alongside juicy motivational packages to encourage more submissions. Above all, the Consortium of Academic and Research Libraries in Ghana (CARLIGH), which has been championing the many digital initiatives of libraries in the country, should think of instituting a national research repository.