Exploring the role of institutional governance in enhancing sustainability performance of health and sanitation projects in Uganda: a qualitative inquiry

Purpose This study aims to examine the role of institutional governance in enhancing the sustainability performance of health and sanitation projects in Uganda. It specifically investigates how governance shapes the economic, social and environmental outcomes of projects. Design/methodology/approach A qualitative research design was adopted, involving 21 purposively selected participants from government, nongovernmental and private health projects across Uganda. Data were collected through semistructured interviews and analyzed thematically using Braun and Clarke’s (2006) six-step framework, with the aid of NVivo software to code and map relationships between governance practices and sustainability indicators. Findings Results revealed that effective governance characterized by coherent policy frameworks, transparent leadership, stakeholder inclusion and adaptive coordination significantly enhances project sustainability. In contrast, bureaucratic rigidity, weak regulatory enforcement and fragmented institutional mandates undermine continuity, accountability and community ownership. Sustainability performance emerged as a function of social value creation (community participation, innovation and social impact) and service governance (accountability, monitoring and inter-agency collaboration). Practical implications This study underscores the need for integrated governance frameworks, ethical and accountable leadership and community co-management systems to strengthen institutional resilience and ensure sustainability. Policymakers and development partners should institutionalize adaptive governance principles in project design, monitoring and policy formulation. Originality/value To the best of the researcher’s knowledge, this is the first empirical study in Uganda to explore how institutional governance influences the sustainability performance of health and sanitation projects. It contributes new theoretical and practical insights by extending institutional theory to a decentralized, low-resource context, illustrating how governance legitimacy, alignment and adaptive capacity collectively shape sustainable development outcomes.