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This study provides an empirical investigation on the effect of top management support: involvement, policies and strategies, and provision of resources on the relationship between the macro environment and the performance of donor funded health projects in Kenya. The study adopted explanatory and descriptive research designs. A census of all the sixty-nine ongoing donor funded health projects initiated between 2008 and 2018 was conducted. A semi-structured questionnaire was administered to managers of the donor funded health projects and the heads of donor funded projects at the Ministry of health. Regression results indicate that top management support had a positive significant effect on the relationship between the macro environment and the performance of donor funded health projects in Kenya. The study recommends top management involvement in projects from the onset, besides developing appropriate policies and strategies for the projects, and providing resources to the projects to ensure they perform well.