Responsible leadership and sustainability performance of health and sanitation projects: the mediating role of resilience

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Purpose Globally, health and sanitation projects continue to face significant sustainability challenges, including weak governance, discontinuity in service delivery, infrastructure deterioration, and limited capacity to withstand operational, financial, and environmental shocks. These challenges are particularly pronounced in developing countries, where many projects struggle to remain functional beyond initial implementation phases, undermining progress toward Sustainable Development Goals (SDG 3 and SDG 6). Despite growing interest in project sustainability, limited empirical evidence explains how responsible leadership influences sustainability performance, particularly through resilience mechanisms in project-based health and sanitation contexts. This study therefore examines the effect of responsible leadership on sustainability performance, with resilience as a mediating variable, among health and sanitation projects in Uganda. Methodology A cross-sectional quantitative research design was adopted using data collected from 520 respondents across 86 health and sanitation projects in Central Uganda. Data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) to test the hypothesized relationships. Findings The findings indicate that responsible leadership significantly and positively influences sustainability performance. Responsible leadership also significantly enhances project resilience, which in turn positively affects sustainability performance. Mediation analysis reveals that resilience partially mediates the relationship between responsible leadership and sustainability performance, suggesting that sustainability outcomes are strengthened both directly through leadership practices and indirectly through enhanced adaptive capacity. Practical implications The findings suggest that policymakers, development partners, and project managers should strengthen ethical leadership, accountability systems, stakeholder engagement, and resilience-oriented project planning, including adaptive governance, contingency preparedness, and shock-response mechanisms, to improve project sustainability performance. Originality /value This study contributes to global sustainability and leadership scholarship by integrating responsible leadership, resilience, and sustainability performance within a single empirical framework. It extends relational leadership theory by demonstrating resilience as a key explanatory mechanism and provides evidence relevant to health and sanitation project sustainability in developing economies.

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