Background: Sustainability of health interventions is a global concern, as program benefits are lost as soon as programs lose donor funding. An assessment of the Uganda Rural Water and Sanitation (RUWASA) project revealed that program gains can be sustained decades later. We analysed RUWASA implementation to draw sustainability lessons for maternal and child health interventions in Uganda.

Methods: Administrative data from 1997 was combined with key informant interviews and focus group discussions in Kamuli and Pallisa undertaken in 2012. Data on borehole installation, coverage of safe water and latrine construction before and after the termination of the RUWASA project was obtained.

Results: Latrine coverage increased from 24% (2001 project end) to 68% (2011) in Pallisa and from 60% (2001 project end) to 83% (2011) in Kamuli districts. Access to safe water increased from 7% (2001 project end) to 68% (2011) in Pallisa and from 38% (2005 project end) to 67% (2011) in Kamuli districts during RUWASA and after it was terminated. Factors crucial to the sustainability of the project included; involvement of communities, community contributions towards installation of the boreholes and mandatory prerequisite of installation of pit latrines by all households prior to borehole installation.

Conclusions: Community engagement, contributions, use of structures and ownership of RUWASA was critical for the sustainability of the intervention. These are critical lessons for sustainability of maternal and child health programs.