Exploring how the sustainability of water and sanitation projects influences community health outcomes in Butambala District, Uganda

Purpose This study explores how the sustainability of water and sanitation projects influences community health outcomes in rural Uganda. Design/methodology/approach A qualitative design was adopted, involving in-depth interviews with 18 purposively selected participants at saturation, including caregivers, LC1 chairpersons, water committee members, borehole caretakers and village health team members. Data were analysed thematically to identify patterns linking sustainability dynamics to hygiene practices and disease exposure. Findings Findings reveal that infrastructure breakdowns directly increase health risks, while weak leadership, limited accountability and low social trust undermine maintenance and community commitment. Coping strategies often involve health trade-offs, and environmental stress further intensifies system fragility. Strong participatory governance and community ownership were found to strengthen both sustainability and preventive health behaviours. Practical implications Practically, the study highlights the need for integrated governance reforms, climate-responsive planning, transparent financial management and strengthened community ownership mechanisms to safeguard health outcomes. The findings suggest that water infrastructure investments alone are insufficient without sustained institutional support and adaptive capacity building. Originality/value The study contributes an integrated sustainability–health perspective, demonstrating that achieving safe water and sanitation outcomes requires not only infrastructure provision but also accountable governance, social cohesion and climate-responsive management in rural contexts.