Unpacking responsible leadership and its impact on sustainability performance: a qualitative inquiry of Uganda's health and sanitation projects

Purpose This study examines how responsible leadership influences the sustainability performance of health and sanitation projects in Uganda. Despite substantial investments, many projects fail to achieve lasting impact due to weak leadership, fragmented coordination and limited community ownership. The study investigates how ethical, inclusive and relational leadership practices can enhance the social, economic and environmental sustainability of these essential services. Design/methodology/approach A qualitative design was employed, involving in-depth interviews with 21 participants working in health and sanitation initiatives across Uganda. Data were analyzed thematically using a constant comparison approach, guided by relational leadership theory (RLT), which views leadership as a relational process grounded in social interaction, mutual respect and shared accountability. Findings Findings show that sustainability performance is strongly leadership-driven and shaped by four interconnected dimensions of responsible leadership: ethical governance, inclusive engagement, strategic foresight, and collaborative work culture. Ethical integrity and accountability build stakeholder trust; inclusive engagement strengthens community ownership; strategic foresight supports continuity under uncertainty; and collaboration fosters team cohesion and adaptive resilience. Together, these practices enhance social value through empowerment and ownership while improving service governance through continuity, monitoring and accountability. Practical implications The study underscores the need to institutionalize responsible leadership practices such as transparency mechanisms, participatory planning, continuity strategies and cross-sector collaboration within Uganda's health and sanitation governance frameworks. Originality/value This is one of the first empirical applications of RLT in the Ugandan context, the study demonstrates that sustainability performance depends not on individual authority or technical capacity but on relational ethics, inclusiveness and mutual accountability.