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This study systematically reviews empirical literature published between 2018 and 2025 to examine how leadership, governance, stakeholder engagement, and resilience contribute to sustainability performance of health and sanitation projects, particularly in developing countries especially Sub-Saharan Africa. The review aims to synthesize conceptual and empirical developments and identify key gaps that may inform future research and policy. Adopting a systematic literature review methodology, this study analyzed peer-reviewed journal articles drawn from major academic databases including Scopus, Web of Science, PubMed, ScienceDirect, Emerald Insight, SpringerLink, Wiley Online Library and Google Scholar. Studies were selected based on relevance, methodological rigor, and focus on low-resource contexts. The review included qualitative quantitative and mixed method studies. The review identifies a growing body of evidence supporting the importance of responsible leadership, institutional governance, stakeholder engagement, and resilience in enhancing health and sanitation project sustainability performance. However, findings also reveal several limitations, including; (i) limited context-specific research in developing countries such as Uganda, (ii) fragmented examination of the combined effects of these factors, (iii) methodological inconsistencies across studies, and (iv) a lack of longitudinal investigations. The study emphasizes the importance of integrated, context-sensitive frameworks to guide sustainable development efforts in the health and sanitation sectors. This review addresses a critical gap by focusing on the interplay among leadership, governance, stakeholder engagement, and resilience dimensions often studied in isolation. The findings offer valuable insights for policymakers, development agencies, and researchers working in resource-constrained settings, especially in sub-Saharan Africa.
Kyambade et al. (Wed,) studied this question.