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A disguised case set in the fictional Central American republic called "Portobello," this case tracks the strategies and efforts of Vice- Minister Jose Manuel Quesada to oversee a reorganization of the country''s public sector health care delivery system. The transfer of jurisdiction of hospitals from the Ministry of Health to the National Social Security System involves much more than bookkeeping. It represents an effort to redirect national health care dollars toward preventive care, especially sanitation, vaccination and maternal-child care. Local health care providers, however, have been accustomed to relative autonomy and, in many cases, have been overseen by local "welfare juntas," who have arranged special privileges for their staffs. The centralization of strategy and priorities in the small republic is destined to spark significant resistance to change. This case is designed to allow for discussion of organizational reform and strategy in developing nations, although its relevance is not confined to such settings.