International non-governmental organisations (INGOs) play an increasingly prominent and multifaceted role in the field of global healthas policy advocates, recipients of donor funds, and implementers of donor-funded programmes. Many such NGOs and their local affiliates have become highly professionalized and oriented towards the priorities of global-level actors, with potential negative consequences for their ability to represent the grassroots and to challenge structures of power and inequality. In this thesis, I examine the dynamics around INGO project implementation in Malawi, within the broader context of overlapping development initiatives, shifting priorities, conditions of scarcity and donor dependence, and poor health outcomes. I draw on ethnographic research conducted in rural Malawi between May 2015 and August 2016, which focused on the implementation of a Save the Children project that aimed to improve maternal health by reducing teenage pregnancies, primarily by keeping girls in school and increasing their use of reproductive health services, notably contraceptives. My ethnographic gaze is on the individuals who serve as intermediaries between donors, northern (I)NGOs and local recipients, who I conceptualise as brokers. They include INGO district staff, primary school teachers, health workers, village heads, and community representatives. Through a focus on their practices, I examine how they translate global norms and aims into programmatic practice. The thesis brings together three peerreviewed articles. The first (in Forum for Development Studies) discusses how primary school teachers deal with, and implement, various overlapping NGO initiatives targeting girls, and the implications for public sector institutions. The second article (in Medical Anthropology) examines how INGOs' programmatic focus on behaviour change interventions inadvertently results in staff blaming culture for teenage pregnancies and school dropout, reinforcing ethnic stereotypes originating in historical inequalities and previous health development initiatives which targeted harmful cultural practices. The third article (in Reproductive Health Matters) analyses the responses of village heads, midwives and women to the reintroduction of userfees for maternal health services resulting from donors' suspension of budget support, shifting national priorities, and unstable service delivery contracts. Overall, I argue that examining the practices of the brokers who implement and reshape health development initiatives can shed light on policy-to-practice gaps and how unintended consequences occur. My ethnographic research thus helps to explain why initiatives might not be sustainable despite the intention of donors and INGOs to strengthen existing public and community structures. 1 This research is led by Professor Sidsel Roalkvam, Co-Investigator Katerini Storeng, and senior researchers at the University of Malawi-Professor Blessings Chinsinga, Peter Mvula and Joseph Chunga. Fieldwork in Malawi has been carried out by three Universit...