This chapter focuses on the following countries: Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Kosovo, Macedonia, Montenegro, Romania, Serbia, and Slovenia. It examines the intended outcomes and unintended consequences of donor-driven assistance and development in South Eastern Europe (SEE), and presents an example of the need to align donor agendas with national priorities that global health leaders and national stakeholders must consider in the field of health and development. Upon gaining independence in the early 1990s, the SEE has embarked on political and economic transformations. In order to ensure effective global health development, donor agencies must truly hold nation-states accountable to the commitments made and must help create not only political buy-in, but also community-level support to the initiatives being undertaken. The role of international donors in global health and development is also contingent upon the changing geopolitical realities on the ground.