¡Not another Manchester book on NGOs! some bookstore browsers will comment on spotting this text. The short response, of course, is 'Yes, another one.' The longer response is this introductory chapter. In it we argue why this is once again a good moment to take the pulse of the NGO world. This time, though, we take the pulse not merely as a health check, which was the spirit of the three Manchester conferences: in 1992 to check their fItness to go to scale (Edwards and Hulme, 1992); in 1994 to check their fItness in the face of increased societal scrutiny (Edwards and Hulme, 1995; Hulme and Edwards, 1997); and in 1999 to check their fItness in the face of globalization (e.g. Eade and Ligteringen, 20m; Edwards and Gaventa, 20m; Lewis and Wallace, 2000). Instead, participants in a conference in 2005 took the pulse of NGOs to see whether the patient was still alive.