National Strategic Plan Costing in Trinidad and Tobago
2010 –2011 || U.S. Agency for International Development
In Trinidad and Tobago, adult HIV prevalence is approximately 1.5 percent and annual incidence is about 1,400 in a population of 1.3 million.1 The National AIDS Coordinating Committee (NACC) developed the country's first HIV/AIDS National Strategic Plan (NSP) in 2004. Subsequently the NSP has been updated and strengthened. Deloitte supported the inclusion of a costing component in the most recent NSP (2011-2016) as a part of the consortium implementing the USAID Health Systems 20/20 project. The NSP costing estimate links the objectives, strategies and activities in the NSP to resources that reflect the anticipated health targets to be achieved during the period of the NSP.
As HIV/AIDS has become a chronic disease and addressing the epidemic has shifted from an emergency intervention to a sustained, integrated response, advocating for HIV resources competes with other chronic condition demands and the trend toward broader health systems strengthening. In order to support a more consistent and sustainable country-wide response, the NACC has implemented iterations of an HIV/AIDS NSP since 2004. Included in the NSP is a costing component to help shape affordable activities as part of the iterative planning process during the NSP development for 2011 to 2016. Deloitte and its collaborators aimed to develop transparent costing estimates to strengthen advocacy for increased investments in a competitive funding environment.
In late 2010, Deloitte supported the development of cost estimates and a costing framework for the NSP using an activity-based costing methodology. Deloitte completed workplan and budget reviews, as well as costing consultations, with NACC NSP counterparts and other key stakeholders, in order to break down broad intervention strategies and objectives into costable activities, focusing primarily on most-at-risk populations including youth ages 15-24, men who have sex with men, and commercial sex workers. The total five-year cost for implementation of activities under the NSP was initially estimated at 77 million USD. Individual activity estimates are dependent upon the final choice of activities, targets, and progress towards the anticipated targets. The costing narrative developed by Deloitte and the Health Systems 20/20 team highlights aspects of the NSP that would contribute to broader health systems strengthening in Trinidad and Tobago.
The iterative costing process supported by Deloitte provided a functional template for the NACC to use and refine as it finalized the NSP activities for submission to the legislature. Following approval, the template may be continuously updated and used for coordinating multi-sectoral planning and for tracking progress against targets and across implementing government and non-government agencies. Transparent costing estimates can help shape Trinidad and Tobago’s national health strategies, strengthen advocacy for increased investments to achieve health targets, and inform planning and budgeting processes.
1 National AIDS Coordinating Committee (NACC) Secretariat, UNGASS Country Progress Report Trinidad and Tobago, 2010.
Deloitte’s work in Trinidad under Health Systems 20/20 is carried out under a subcontract with Abt Associates Inc., prime contractor for the Health Systems 20/20 cooperative agreement. Health Systems 20/20 is funded through the generous support of the American people through the U.S. Agency for International Development (USAID). The project helps USAID-supported countries address health system barriers to the use of life-saving priority health services. In the process, the project works to strengthen health systems through integrated approaches to improving financing, governance, and operations, and building sustainable capacity of local institutions.
As used in this document, “Deloitte” means Deloitte Consulting LLP, which provides strategy, operations, technology, and human capital consulting services, Deloitte Financial Advisory Services LLP, which provides financial advisory services, and Deloitte & Touche LLP which provides governance and risk oversight and reporting advisory services. These entities are separate subsidiaries of Deloitte LLP. Please see www.deloitte.com/us/about for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. Certain services may not be available to attest clients under the rules and regulations of public accounting.