ART Costing Tool Crosswalk: Marginal Budgeting for Bottlenecks (MBB) Toolkit

Marginal Budgeting for Bottlenecks (MBB) Toolkit

Link to ART Costing Crosswalk Analysis Table (PDF, 34 KB)

Model Methodology

  • Epidemiological data is based on the UNAIDS costing tool.
  • Present levels of coverage are estimated using some of the following: household surveys, poverty maps, health information systems, facility surveys, geographic information systems, exit interviews, direct treatment observations, focus groups, etc.

Questions Answered

Identifies implementation constraints of the health system that should be removed to optimize expected health outcomes. Estimates the marginal/incremental resources required for overcoming those constraints and achieving better results. Relates these resources to the country’s macroeconomic framework.

  • What are the major hurdles or “bottlenecks” hampering the delivery of health services, and what is the potential for their improvement?
  • How much money is needed for the expected results?
  • How much can be achieved with health outcomes such as mortality reduction by removing the bottlenecks?
  • What amounts of financing need to be mobilized and how should this funding be allocated and channeled?

Program Areas

  • Demography, epidemiology, health services, intervention coverage, and costs are included.
  • Includes all health-related Millennium Development Goals, but in HIV prevention and care: PMTCT (testing and counseling, ART, and infant feeding counseling); condom use; and cotrimoxazole prophylaxis for mothers living with HIV.

Data Outputs

  • Outputs include marginal/incremental cost per input, per bottlenecks, and service delivery mode.
  • Estimates costs, coverage, and calculates resource requirements (intervention cost).
  • Costs are also presented in budget format (budget and financing).


  • Assumes that spending is targeted to the more cost-effective health interventions.
  • It may not address risks from the political economy of health spending (e.g., that parts of the health system that are less cost- effective may be of particular interest to political elites).
  • Implicitly, it is assumed that these health care costs are financed by private spending, given the scarcity of government and aid financing.
  • Not publicly available.

Online Access

Model not publicly available. Available upon request.

Contact(s) for more information:


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