The following deficiencies are the contributing factors to many challenges that the Grant is faced with: . Poor management of the professional service providers in many cases; Poor management of the implementing agent; . Inadequate norms and standards; . Poor input into quality planning, design, specification. Voluminous but very inadequate project briefs (poor planning), inadequate and wrong design, wrong health technology and other equipment and frequent and costly modifications (poor planning); . Frequent and costly changes on the scope of works; . Poor quality and quantity of project spending contributing to late payments; . Lack of, or poor involvement of the management of the facilities under revitalisation and to some extent other stakeholders; . Poor oversight, communication, coordination and reporting; . Poor performance of the roles and responsibilities by the health departments in the project development and management cycle; . Inadequate project management systems in place; . The State is always the loser in fee negotiations (if any) with professional service providers; . Ignoring the potential savings on repetitive designs and documentations in many instances; . Poor and lengthy procurement process, sometimes taking eight to nine months before the contract is awarded; . Poor contract management, administration and communication contribute to high costs and time over-run; many variation orders; abandoned projects or never-ending projects; poor quality workmanship of the contractors and late payment; and . Non-closure of many projects. Files are still open and retention moneys are not paid as building plans and manuals are not produced or are not delivered to the client. Some projects are outstanding for the past seven years.