The study set out to understand the differences in public expenditure governance practices and perceptions in the delivery of PHC, between the best performing and the poorly performing districts on the MoH district league table of FY 2016/17. Overall, based on the PEG Assessment Framework indicators, the best performing districts were found to be better in most governance aspects namely, participation, accountability, coordination, control of corruption, responsiveness, equity, effectiveness and efficiency. On the other hand, the category of the poorly performing districts on the MoH district League table performed better in strategic vision in the governance of PHC funds. The specific conclusions against the respective governance principles are summarised below; Strategic Vision: Against the conclusions made in the preceding section, this section presents key recommendations for various actors at both local government and central government level. While the study was undertaken at local government level, deductions made herein have applications at central government level as well. This is due to the structure of public expenditure in PHC which sees government play a central role in its governance and decision making. For instance, the PHC grant utilisation guidelines are set at central government level. It is for this reason that some of the recommendations presented hereunder are addressed to MDAs at central government level. Overall, it was noted that the existence of the sector grant guidelines is critical to the adherence to sectoral and national priorities at all local government and health facility level. However, there is no consistency in the percentage breakdowns of the budgets spent on the respective items.