This mixed-methods study aimed to understand the role of principal leadership in implementing a primary reading intervention in Ghana, a subject under-studied despite the country's policy focus and global evidence of leadership's positive impact on school outcomes. We investigated how principals approach leading the intervention, what effects their leadership behaviors have on student reading, and why these effects occur. Quantitative data included teacher-rated principal implementation leadership surveys and student reading assessments collected from 393 teachers and 3521 students from 198 randomly sampled primary schools nationwide. Qualitative interviews were conducted with three principals and five teachers from a subset of three schools. We found that while most principals struggle with implementation leadership, those who excel in these roles are associated with significantly higher student reading performance with effect sizes between 0.26 and 0.43 standard deviations. Interviews revealed that outstanding leaders proactively adapt to new practices and hold teachers accountable with firmness and empathy, even when facing resistance. These findings highlight the need for robust leadership development to maximize the efficacy of school interventions in contexts like Ghana's.