IntroductionThe Water-Energy-Food and Health (WEFH) nexus has gained prominence as an approach for improving policy coherence across interconnected sectors. In low- and middle-income countries, donor agencies play a central role in shaping WEFH policies and interventions. However, the influence of donor-recipient interactions on local-level WEFH governance remains underexplored, despite implications for priority-setting, resource allocation, and sustainability across sectors.MethodsWe conducted 20 key informant interviews with stakeholders from government ministries, development agencies, and civil society, purposively sampled to capture diverse positions across the WEFH governance landscape. Document reviews were used to corroborate and validate interview findings. Data were analyzed using thematic analysis, with NVivo software supporting coding and data organization.ResultsThe findings show that donor agencies significantly shaped WEFH governance across six action situations: policy formulation, program design, resource allocation, inter-ministerial coordination, monitoring, and international policy alignment. While ministries maintained formal authority, donor funding and technical assistance influenced policy priorities, where programs were implemented, and resource distribution. Rules-in-use, particularly boundary, choice, and payoff rules, were redefined through donor conditions. Participation also remained asymmetric, with local governments and non-core ministries excluded from upstream decision-making. These interactions led to varying governance outcomes: improved coordination efficiency, enhanced attention to equity and inclusion, strengthened institutional capacity and policy alignment with frameworks. However, they also reinforced fragmentation, spatial inequities, accountability tensions, and sustainability challenges beyond donor project cycles.DiscussionThese findings show that donor-recipient interactions are not merely financing relationships, but governance mechanisms that shape decision-making, participation, resource allocation, reporting, and accountability in WEFH systems. Externally funded governance can create hybrid action situations in which formal state authority and donor practical leverage diverge. Strengthening WEFH governance therefore requires earlier inclusion of subnational actors in upstream decision-making, harmonized reporting systems across donors and ministries, equitable financing arrangements, and stronger alignment of donor support with national priorities and local realities.