Sustainability challenges in Uganda's health and sanitation projects: an institutional perspective

PURPOSE: This study examines why health and sanitation projects in Uganda struggle to achieve sustainability despite substantial investments, supportive policies, and global commitments. DESIGN/METHODOLOGY/APPROACH: Guided by Institutional Theory, the study adopts a qualitative design involving 21 semi-structured interviews with project managers, government officials, NGO staff, health inspectors, and community mobilizers. Data were thematically analyzed using Nvivo. FINDINGS: Results show that fragmented governance, weak policy coherence, and short-term donor cycles constrain institutional alignment. Low community ownership, weak feedback systems, and donor-local power imbalances undermine accountability, while leadership gaps, corruption, and limited technical capacity further weaken resilience. Together, these factors explain why sustainability remains difficult to institutionalize in Uganda's health and sanitation sector. PRACTICAL IMPLICATIONS: The study calls for integrating interventions within national institutional frameworks, strengthening local accountability, and enhancing ethical and technical leadership. Donors and policymakers should support long-term learning, participatory design, and sustainable local financing. ORIGINALITY/VALUE: This study provides one of the few empirical analyses of sustainability challenges in Uganda's health and sanitation projects. By applying Institutional Theory, it offers a systemic view of how governance, leadership, and community legitimacy shape project continuity and resilience.