Co-ordinating collective work and communicating a shared understanding of tasks is necessary to accomplishing organizational goals. Stigma could exacerbate co-ordination challenges between public and private organizations by further widening differences in goals and incentives among employees. Using relational co-ordination theory, we explore how stigma can influence employee behaviour in the context of healthcare delivery. We study healthcare professionals and frontline workers involved in the fight against AIDS in India to examine how public health systems fail due to a lack of communication and co-ordination, and that these failures are worsened by stigma. When stigma is present, relationships between employees become strained due to misaligned work routines, lack of information sharing and cooperation failure. Our findings reveal emergent responses from frontline employees that mitigate co-ordination failures through: (1) role adaptation to improve predictability of tasks; (2) social purpose identification to promote a common understanding and engage stigmatized clients; and (3) affective attachment that encourages extra-role behaviours and task ownership. We draw implications for relational co-ordination and stigma, as well as public-private co-ordination in public health systems.