This thesis has sought to illuminate how the operations of a national health system can be understood using a theoretical global health governance (GHG) lens. A national health system usually operates within the parameters of the government and the state. So how does it affect the operation of a national health system to receive financial and technical support from external actors? This thesis uses the Malawian health system as a case study of how ideas of global health are interpreted in a national health system. Malawi was chosen as a case because the country’s health system is largely financed by external actors, as the government is unable to finance the operation of the health system. This qualitative study is based on textual analysis of the Health Sector Strategic Plan [2011-2016] and interviews with important actors in the Malawian health sector. The aim of this is to gain deeper understanding of the mechanisms that are happening in the health system as a result of external influences. The main findings from this study are that external actors and partners in the Malawian health system have two main influences. The first is the enforcement of parallel systems of health care delivery in the decentralised health system. The second finding is that the external actors exert resource-based power over priorities in the health sector, through their access to financial resources.