Growing overlaps in medical infrastructure and responsibilities across institutions in a context of economic stagnation in the 1970s soon alerted government to costly inefficiency and to governance problems.
Having worked in the sector for many years with a vast number of charities, I know that the strategic management in many charities is relatively poor, which in turn leads to poor governance, failings and inefficiencies.
More specifically lack of law and order is reflected through high levels of unfair competition, informality, uncontrolled corruption, court inefficiency, and governance effectiveness.
What is complicated is that each of these topics quickly leads to the broader problems facing Guatemala and Central America, including sharp inequalities and exclusion of many groups from education and employment, gang violence and drugs, and perhaps most of all, deep-seated poor governance, meaning political dysfunction, inefficiency, and deeply embedded corrupt practices.
But other government-level inefficiencies remain.
"You remove all these inefficiencies, you improve governance," says Bitange Ndemo, the top civil servant at Kenya's Ministry for Information and Communication.
On the contrary, it is the United Nations that has lost influence with the United States as a result of its years of tolerance of, and governance by, dictatorial and corrupt governments, its gross inefficiencies and bureaucratic inertia and its status as a bloated, ineffectual debating society with no capability, or even desire, to see its edicts enforced.
A single price cannot meet these differing objectives, but no pricing or underpricing leads to inefficiency, inequity, and mis-governance.
Institutional and governance failures which induced gross distortions and inefficiency in production, investment choices and high costs of operation, low return on investment, and expensive delays along with cost overruns in the state energy enterprises.
We also explain the inefficiency of public transport operators by the internal corporate governance.
