When implementing a transformational global vision and mission, three problems typically confront international NGOs: aligning different levels of planning and strategy; balancing global analysis and priorities against local realities; and identifying measures that both indicate progress and promote and encourage innovation. This article reports on the efforts of CARE International's Latin America Regional Management Unit to address these problems by introducing 'reversals' to common strategic planning principles and processes. It shows middle managers in NGOs how they can lead 'from the middle', and considers 'the region' to be the nexus enabling an organisation to change and learn across multiple hierarchical levels.