A Qualitative Exploration of Social Sustainability Performance in Health and Sanitation Projects

ABSTRACT Social sustainability is increasingly recognized as a critical dimension of sustainability performance in health and sanitation projects, yet it remains significantly underexplored compared to technical, financial, and coverage‐based indicators. This study examines how communities, local leaders, and project staff in central Uganda understand, experience, and enact the social sustainability performance of health and sanitation projects. Using a qualitative exploratory design, 21 participants were purposively selected, including community members, local council leaders, and frontline project implementers. Data were collected through semi‐structured interviews and analyzed thematically following in 2006 Braun and Clarke framework. The findings reveal five core processes underpinning social sustainability performance activities: meaningful participation, trust‐building and legitimacy, perceived fairness and inclusion, community‐led maintenance and stewardship, and social cohesion supporting collective action. Participants emphasized that project sustainability extends beyond physical infrastructure or initial adoption and is deeply rooted in relational dynamics, how communities feel respected, included, and empowered, and whether project activities align with local norms, interests, and social structures. The study demonstrates that the continuity of health and sanitation interventions depends heavily on community acceptance, feelings of ownership, and sustained engagement over time. The findings advance theoretical understanding of social sustainability by anchoring it in lived experiences and highlighting its relational, behavioural, and cultural dimensions. Practical and policy implications underscore the need for participatory planning, trust‐based leadership, culturally grounded project design, and institutional support for community‐driven maintenance systems. The study concludes that achieving long‐term sustainability in health and sanitation projects requires shifting from completion‐focused metrics to socially grounded, community‐centered performance indicators.