Expenditure reviews appear to be useful for identifying the flow of public funds and their use. A key finding of most surveys is public resource leakage. They also highlight the problem of delays and bottlenecks, payroll ghosts, equity in resource allocation, information asymmetry and poor record keeping.

Challenges highlighted in the literature include:

• Surveys can be expensive and difficult to conduct.
• Resource flows are often complex and data may be unreliable or unavailable making leakage difficult to measure.
• In some cases an absence of strict allocation rules make it difficult to design effective techniques to determine the amounts of money allocated to a particular region or facility.
• Translating the findings into policy reforms and institutional changes is seen as a major challenge.

Few countries are found to effectively follow-up on reform suggestions that are identified by tracking surveys. Lack of political will is often a factor behind weak institutional change. There is often lack of policy dialogue, insufficient dissemination of results and discussions to ensure the transfer of information about problems identified in the service delivery system. Surveys should be assessed on their capacity to induce policy reforms to correct the various governance problems identified.

Suggestions for dissemination and follow-up include:

• Strike a practical balance for making findings from a survey actionable. Help define key priorities and tractable options for addressing weaknesses in prevailing systems.
• Carefully align the timing and dissemination of the survey results with the event schedules of both government counterparts and the wider public.
• Partnerships between the government and civil society or user groups can significantly enhance the capacity of the government and perform an oversight function in ensuring the delivery of services.
• Approach a survey as a routine part of the ongoing monitoring and analysis process.
• Establish a survey monitoring and follow-up mechanism.