This study explored the current levels and challenges/barriers facing teacher participation in school decision-making in the Cape Coast Metropolitan area and Mfantseman Municipality in the Central Region of Ghana. The study employed the explanatory sequential mixed method design involving semi-structured interviews with 11 teachers, 4 head teachers and 4 circuit supervisors. Furthermore, questionnaires were administered to 209 teachers, 26 head teachers and 11 circuit supervisors. The SPSS version 20 and the Nvivo software version 10 were used to analyse the questionnaire survey and the semi-structured interview. In a micro ethnographic study, teachers and head teachers from 2 schools that recorded the highest and lowest teacher participation in school decision-making were subsequently observed during staff and Parent Teacher Association (PTA) meetings. In addition, their documents such as staff and PTA minutes books were also analysed. Classroom, committee/group and school levels emerged as the levels of teacher participation in school decision-making. However, few teachers were found participating at the school level, while the majority participated at the classroom level, with some at the committee/group level. The study found that unilateral decisions by head teachers, unimplemented decisions and insufficient funds were the challenges/barriers to teacher participation in school decision-making. Nevertheless, almost all the teachers, head teachers and circuit supervisors agreed that there should be regular training for head teachers with regard to the tenets of school decision-making and leadership to enable them fully involve teachers in all issues concerning the school. The study concludes that for teachers to participate fully in all school decision-making and for schools to improve, head teachers need to motivate teachers, consult them, trust and be transparent to them in all school related issues. Furthermore, the researcher recommends a nationwide training of head teachers and decentralisation of power in schools. At the school level, teacher empowerment, creating instruction-oriented structures and teacher motivation are the key to effective teacher in PSDM.