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Three years ago, the Mexican Social Security Institute (IMSS), a highly centralized and hierarchical organization, started to devolve powers to its service units, grouped in decentrally managed medical areas (AMGDs). It was a slow process until a project was set up to create the necessary tools to administer the new decentralized system. Dr. Martín is the head of one of the new medical areas. He and his bosses have made the necessary changes to make the AMGD work. The case discusses the roles of management and strategy, linking them to the role that the health ministry must play in any devolution process.