Theorizing sustainability performance in Uganda's health and sanitation projects: a multi-theoretical approach

Purpose This study explores how responsible leadership, stakeholder engagement, institutional governance, and resilience influence the sustainability performance of health and sanitation projects in Uganda. It adopts a multi-theoretical approach combining relational leadership theory, stakeholder theory, institutional theory, and resilience theory to develop a comprehensive understanding of how these dimensions interact to sustain development outcomes. Design/methodology/approach A qualitative storytelling narrative approach was adopted, guided by semi-structured interviews with 21 participants drawn from government, private, and community-based health and sanitation institutions across Uganda. The storytelling structure of context, actions, results, and lessons was used to interpret participants' lived experiences. Data were analyzed thematically following Braun and Clarke's (2006) six-phase framework. Findings Findings reveal that sustainability performance in Uganda's health and sanitation projects is shaped by four interrelated forces: responsible leadership that fosters collaboration and accountability; stakeholder engagement that strengthens ownership and continuity; institutional governance that ensures policy coherence and transparency; and resilience that supports adaptive management amid resource and environmental shocks. The study shows that sustainability emerges when leadership behaviors, institutional arrangements, and community participation coalesce into adaptive, legitimate systems capable of enduring uncertainty. Practical implications The study underscores the need for participatory governance structures that integrate leadership development, stakeholder empowerment, and institutional accountability. Building resilience through flexible planning and continuous learning is crucial for sustaining project outcomes in low-resource and decentralized contexts. Originality/value This is the first study in Uganda to empirically theorize sustainability performance in the health and sanitation sector through a multi-theoretical lens. It advances a work-applied understanding of how governance, leadership, and engagement practices interact to influence long-term project success in fragile institutional settings.