Stakeholder priorities for sustaining operations and maintenance of school sanitation facilities in Kampala City, Uganda.

Introduction: Sustaining sanitation services in schools in low resource settings requires effective operation and maintenance (O&M), yet the relative influence of management on service reliability remains poorly understood. Methods: This study employed a participatory multi-criteria decision-analysis (MCDA) design to identify stakeholder-derived priorities for O&M of sanitation facilities in Kampala schools. The Analytic Hierarchy Process (AHP) was used to weigh domains, and the SWING method was used to prioritise indicators. Stakeholders were selected using purposive sampling techniques. Participants included practitioners from civil society organisations involved in school sanitation programmes, and regulators from relevant ministries and Kampala Capital City Authority (KCCA). The sample also included researchers who had published on sanitation in Kampala, as well as Head Teachers and Sanitation Teachers from the study schools. Thirty five stakeholders attended a facilitated workshop and completed structured AHP and SWING weighting exercises. The data collection instruments were adapted from standard MCDA templates and customised for the school sanitation O&M context. Their validity was strengthened through expert review, pre-testing, and structured participant orientation. AHP consistency ratio checks were also conducted, and all responses met the required threshold (CR ≤ 0.1). Bootstrap confidence intervals were generated to assess robustness. Results: Service planning (0.234), resource management (0.199), and facility design standards (0.193) were ranked as the most influential domains. Governance (0.166), service delivery (0.137), and monitoring and evaluation (M&E) (0.071) were assigned lower weights. The highest priority indicators were the presence of an O&M plan, a dedicated budget line, clear roles and responsibilities, effective budget implementation, and reliable water supply. Conclusions and recommendations: These findings show that sustained sanitation service provision depends more on effective planning, predictable financing, accountability, and reliable inputs than solely on infrastructure. It is therefore recommended that schools sanitation programmes prioritize strengthening O&M planning, budgeting, and M&E systems to improve sanitation service reliability in resource-constrained school settings. Graphical Abstract: Supplementary Information: The online version contains supplementary material available at 10.1186/s12982-026-02148-x.