This volume examines how local actors respond to Africa’s high dependence on donor health funds. It focuses on the large infusion of donor money to address HIV and AIDS into Malawi and Zambia and the subsequent slow-down in that funding after 2009. How do local people respond to this dynamic aid architecture and the myriad of opportunities and constraints that accompany it? This book conceptualizes dependent agency, and the condition in which local actors can simultaneously act and be dependent, and investigates conditions under which dependent agency occurs. Drawing upon empirical data from Malawi and Zambia collected between 2005 and 2014, the work interrogates the nuanced strategies of dependent agency: performances of compliance, extraversion, and resistance below the line. The findings elucidate the dynamic interactions between actors which often occur “off stage” but which undergird macro-level development processes.