Costing tools

Marginal Budgeting for Bottlenecks

UNICEF/The World Bank

Graph illustration

Aims at estimating the potential impact, resources needs, costs and budgeting implications of country strategies to remove implementation constraints of the health system. It estimates the marginal/incremental resources required for overcoming those constraints, and achieving better results and relates these resources to the country’s macro-economic framework.

MBB is intended to help formulate medium-term national or provincial expenditure plans and poverty reduction strategies that explicitly link expenditure to health and nutrition MDGs. MBB is meant to facilitate a process of budgeting for government health expenditures that provides a basis for policy dialogue and planning. One of the strengths of the tool is that it helps simulate the potential impact as well as cost and budget implications of alternative health service delivery strategies using different integrated production functions (community/family based, population/outreach based, or clinic based)


Rudolf Knippenberg
Susie Villeneuve
Netsanet Walelign
Agnes Soucat

Summary of main features

Purpose Planning and forecasting the potential cost and impact of scaling up investments to increase the intake, coverage and quality of high impact health interventions; and preparing results oriented expenditures programs and health budgets
Health MDGs addressed 4, 5, 6
Scope of interventions Maternal, newborn, and child health interventions based on Lancet (2003 and 2005 series); BMJ and Cochrane review. Malaria based on RBM review. AIDS based on UNAIDS costing tool
Type of software Excel-based
User manual available Yes
Potential users Programmers and planners at national, sub-national and district levels
Skills required Health, economics, epidemiology, statistics, basic knowledge of Excel
Type and length of training required A five-day training course that can be done two ways: At the regional level, regrouping five to six countries, or at national level with a country application. Both types require a multidisciplinary national team blending competencies in health, economics including macroeconomics, epidemiology, statistics
Costing strategy and methods Identify tracer interventions as proxy for a set that face the same health system bottlenecks, identify current coverage of those tracers and the costs and health impact of possible ways to remove the bottlenecks they face. Quantities and prices of additional inputs required to remove systemic constraints; locally collected and validated by expert groups
Level of aggregation District, sub-national and national
Program/system costs included Yes
Modeling intervention impact or interactions on epidemiology or demography Yes
Time-frame Medium-term
Output Marginal/Incremental cost per input, per bottlenecks and service delivery modes
Automatic generation of reports Yes: O-Summary sheet that provides estimated mortality reduction reached due to selected strategies and estimated marginal cost needed to implement these strategies
Country applications Include Angola, Benin, Burundi, Burkina Faso, Cameroon, Comoros, Cote d’Ivoire, Ethiopia, Ghana, Guinea, Guinea Bissau, India, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Niger, Nigeria, Rwanda, Sierra Leone, Swaziland, Uganda, Zambia.