Organizational Challenges presents cases that are real life incidents drawn from the experiences of people in different types of organizations in the English-speaking Caribbean, and that give an indication of the wide range of knowledge and skills that managers need in order to effectively and efficiently perform their management functions. The cases are classified under the following broad headings: public administration; health management administration; health care delivery systems; general management. The intention in presenting these casses is to provide the potential or practising manager with some examples of the problems of management in large-scale organizations and to demonstrate to the reader some of the disconnect between the guiding principles of theories of management and the real challenges faced by those who practise the craft of managing. These cases should find acceptance at any level of management, and should be a useful learning tool for the growing number of adults with long years of working experience who are returning to the education system as part time students. The 'dramatic' style of most of the cases is meant to attract the attention of readers in a largely oral culture (the Caribbean) where the how of what is said is so important to understanding a given situation.