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The AIDS/HIV crisis hit Africa especially hard and continues to reshape community and family as many members die leaving broken social structures behind.   At its onset, it was critical for health practitioners to raise topics that were until then left unspoken such as the use of condoms, the benefit of circumcision, and risky sexual practices, this, alongside other health challenges such as drug-resistant strains of malaria and increased prevalence of tuberculosis.

In one particular country of Africa, the HIV/AIDS prevalence continues to be the highest in the continent. This in part is because the rulers of the country did not recognize HIV/AIDS until 2005. This denial left many of its people at risk for contracting the disease without the proper information and precautions. In 2005, international agencies stepped in to prevent the disease; treat those who had it; and promote education to reduce the risk of contracting HIV/AIDS.



In the first 8 years of operation, the specialized health ministry was successful in blunting the spread of HIV/AIDs by informing the majority of the population about AIDS/HIV; how to avoid it; and where to gain testing and treatment. In 2012, the field had changed and people now needed to maintain their health on a cocktail of medications; children were raising themselves as their parents had died of HIV/AIDS; without traditional family structure and support, many children found it acceptable to provide sexual favors to older men in exchange for material items thus contracting the virus. AIDS/HIV’s impact had shifted its focus and impact on the country’s population yet the priorities of the health ministry had not.

The health ministry enjoyed rapid growth since 2005, tripling in size. Many of the informal organizational practices worked well while the organization was small, yet these practices were no longer well with an organization much larger in scope. International funds were being poorly and even improperly distributed threatening the inflow of future grants. As a result, two major management consulting firms were hired to assess the organizational challenges and make recommendations so that the threat of losing future funding could be stymied.

The consulting groups came and went leaving reports (that had cost the ministry millions) filled with numerous recommendations.   Despite these thorough reports, nothing changed at the ministry. After one year, the organization moved into crisis. Morale was low; intellectual capital was lost through numerous resignations; and the once stellar service the organization provided to the community was stalled. Moreover a clear direction as how to promote health and prevent HIV/AIDS was non-existent.


The major challenges to stepping into a true leadership solution were 1) the leadership and Board had already self-diagnosed the problem as “technical”: the Finance department not operating well and the senior managers needing to learn mentoring skills; and 2) the organizational culture had slipped into a “toxic” mode in which people did not interact; communication was through back-channeling; and organizational equipment was taken home and often kept without any repercussion (such as video equipment and laptops), and 3) there was little belief within the organization that another international consultant could be of any use.


Often times, consultants are asked to jump into action to quickly solve the presenting problem. However, a lot of time and energy is often lost by not giving enough time to diagnose the situation correctly.

Just as a physician needs to diagnose the symptoms of an illness one presents in a medical office (if the doctor does not bother seeing you and simply writes a prescription sight unseen neither would his medical ethics be in place nor your well-being); our consultants take the time to analyze symptoms both reported and unreported. It is critical to look beneath the surface of what is being said and what is seen to gather additional data. More data provides stronger hypotheses.

I noticed immediately that there was no life in the building. The doors were closed, there were no employees speaking in the hallways or common areas. I thought perhaps it was the time of day so I went out of our team office to sample the surroundings at various time and days and found this atmosphere to be consistent. Even at lunch time, people used the kitchen refrigerator to withdraw their lunches and disappear. Often, there was only one person utilizing the 30 chairs available at various tables in the dining area.

I also sat down at meetings and observed how things were flowing. I wanted to see if there was enthusiasm, engagement, or just the opposite. In this case, I saw very loud non-verbal language of managers who were doodling, playing with their phones; and some even buffing their nails. And yet the CEO continued to hold the meeting with very little insight as to how his followers were not following.

We listened to leadership, management, and the Board’s diagnoses of the challenges. They knew what was not working in their organization, yet they had little response to what they thought was working well. This asset-based approach to consulting is critical to understanding that which is healthy and unhealthy in order to support change. The CEO identified the finance department and the senior managers as the issue; the senior managers identified the CEO and the staff as the issue; the staff identified a lack of policy and procedures to follow and they were damned in any way that they tried to be effective.


I have always found that a qualitative and quantitative approach of collecting data provides the greatest insight, as qualitative data informs quantitative and vice versa. I decided to focus on the collective wisdom that existed within the organization and to go directly to employees for their insight through semi-structured interviews. In addition, it was critical to assess the level of readiness for change through one of Attuning’s proprietary assessment tools.

The results across the qualitative and quantitative assessment were clear; employees felt underutilized, bullied, frustrated, angry, and despairing. The organization was stuck and withering. There was a minimal feeling of trust and camaraderie.

I often run experiments myself to understand workflow patterns. In this case, I requested a larger lamp for our team work room. After 5 requests and countless promises, the lamp was never delivered. The process involved 5 people to order the lamp (although there were available lamps in empty office spaces), and in the end there was no lamp delivered. This gave me an idea of how employees trying to achieve outcomes may be hampered in their work.

It was time to speak truth to power. This can be dangerous if you are inside the organization given power differentials or the ease in which many will collude in ignoring the “pink elephant” in the room.


When you work in leadership consulting, it is critical to be a mirror to an individual or an organization, no matter what that mirror reflects. In fact, many organizations hire one for that very purpose. At Attuning.Org, we speak truth to power in order to create change so that individuals and organizations can survive and then thrive. I found that as I moved away from the technical challenges which the community was well aware of, and instead, talked about the culture of learned helplessness and how various groups were colluding in keeping the organization exactly as was, hoping that having a new CEO, a new computer system, or a new staff will make all right.

In fact, most community members felt that no matter what they did would be met with dismissiveness or disrespect, leading people to stay within their offices and bide their time. Many decided that because of the bad atmosphere, taking organizational property was justified.

Change comes slowly as most of us prefer to be within the familiarity of what we know, however poorly it is working, then deal with loss and the uncertainty of newness.

We created a 4-step adaptive change process for the organization that was required at all levels of the organization. After six-months, step 1 is nearing completion. Some people are more hopeful; others have left the ministry. The pull to the default is tremendously powerful in any situation but even more so with this organization.

However, the call to service by a majority of the employees started the movement to adapt to the new public health HIV/AIDS needs of today and move away from the previous model. From within and without, there are now enough change agents supporting change and allowing for even more opportunity to take small steps to being an adaptive organization. This adaptive shift needs to be in place before the many technical issues can be addressed.

The key: set up individuals and the organization for success and let that create an upward spiral of ownership and constructive change.

Erik Gregory, Ph.D. |

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Hi, I'm Ligia, business strategist and co-founder at I am interested in the concept of teaching through games and play. You can also find me on Twitter and Facebook.

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