The rapid expansion of higher education in Asia has been accompanied by challenges with no easy solutions and by issues that require innovative thinking and policy decisions. This publication focuses on the challenges in improving the internal efficiency of higher education institutions (HEIs) in Asia, examining the quality of the work done within these institutions; the efficiency and effectiveness of that work; and the problems, dilemmas, and barriers that HEIs in Asia face in fulfilling their missions. Recommendations are presented on how the Asian Development Bank and possibly other development partners can target project support to help HEIs improve their internal efficiency.