Belize is faced with the challenge of alignment of development aid with national health development priorities; and harmonization of international strategic collaboration and partnership as it relates to the sustainability of its National Health Insurance (NHI) Scheme.   The objectives of this paper is to examine the degree/magnitude of harmonization of international technical and financial cooperation on the design and implementation of the National Health Insurance Scheme in Belize; and then to make recommendations on mechanisms to enhance the harmonization of technical and financial cooperation among international development partners and alignment with national priorities for future NHI roll-out.  The study employed a qualitative approach with a comprehensive literature review buttressed by interviews conducted with the Ministry of Health, Social Security/NHI, and other relevant stakeholders in order to aid data collection. The results indicate that in fact there was minimal financial cooperation but greater technical cooperation as it relates to the National Health Insurance Scheme.  The study concluded that whilst Belize has exposure to and experience with international cooperation, Belize’s national health priorities have remained goal-oriented and whilst technical and financial cooperation has been engaged, it has not allowed for priority shifts to align with these funding.