An understanding of the nexus of organic fertilizer use decisions that smallholder farmers take is essential to designing relevant policy to support adoption in sub-Saharan Africa. In this paper, we applied exploratory factor analysis (EFA) on observed farmer decisions to identify a set of common management approaches that farmers in the northeastern part of Ghana adopt in using organic fertilizer. After identification, seemingly unrelated regression (SUR) analysis was applied to relate each approach to farmer characteristics that influence uptake decisions. The EFA identified four approaches, labeled as Augmentary Compost Use Approach, Urban Human Waste Organic Fertilizer Approach, Integrated Livestock Manure Approach and Mineral Fertilizer Cost Constraint Organic Approach. Each of the first three approaches involves a set of strategic farmer decisions which could be supported to increase organic fertilizer use. The SUR analysis showed that the uptake of each approach is affected by different subsets of farmer characteristics. However, participation in organic fertilizer management training positively influences the adoption of all four approaches. Thus, we recommend free training of smallholder farmers as a core element of any policy package to support organic fertilizer adoption.