Understanding stakeholder engagement for improved sustainability performance of health and sanitation projects in Uganda: a qualitative inquiry

PURPOSE: This study examines how stakeholder engagement influences the sustainability performance of health and sanitation projects in Uganda. It aims to uncover how engagement practices ranging from consultation to co-creation, shape economic, social, and environmental outcomes in a low-resource context. DESIGN/METHODOLOGY/APPROACH: A qualitative research design was adopted, using in-depth interviews, field observations, and document analysis with 21 participants. Participants were purposively selected for their strategic involvement in health and sanitation projects, and data collection continued until thematic saturation was achieved. Thematic analysis was applied, guided by Stakeholder Theory and Elkington's Triple Bottom Line (TBL) framework. FINDINGS: Five key themes emerged including community concerns, communication, governance approaches, project oversight, and ownership perceptions. Inclusive participation and transparent communication enhanced trust and community ownership; governance and oversight mechanisms strengthened accountability and resource efficiency; while capacity building and cost-sharing supported long-term project viability. These findings demonstrate that meaningful stakeholder engagement reinforces sustainability performance across economic, social, and environmental dimensions. PRACTICAL IMPLICATIONS: The study provides actionable insights for policymakers and practitioners by emphasizing the need to institutionalize inclusive participation, strengthen accountability frameworks, and promote shared ownership through co-financing and capacity development. Such measures can transform stakeholder engagement from a procedural formality into a strategic enabler of sustainable development. ORIGINALITY/VALUE: To the authors' knowledge, this is among the first empirical studies to advance the understanding of stakeholder engagement and sustainability performance within Uganda's health and sanitation sector. The study contributes to theory by extending the application of Stakeholder Theory and Elkington's TBL to a developing-country context, demonstrating how relational and procedural engagement mechanisms translate into tangible sustainability outcomes.