This paper based on the Nepalese and Cambodian construction environment discusses some of the factors which affect the efficiency in project delivery system in the least developed countries. Only several infrastructure development projects were completed within the planned resources in the traditional project delivery system. In addition to the financial problem, lack of bridging the design and construction, inadequate construction management knowledge and skills in the construction engineers, and lack of appropriate human resource development system are the main reasons for poor performance of the Nepalese and Cambodian construction industry. Alternative project delivery systems are discussed and incorporation of the construction management system to improve the situation is proposed.