A Guide to Contracting for Health Services During the COVID-19 Pandemic

World Health Organization together with International Finance Corporation issued a new guide to contracting for health services during COVID-19 pandemic.
Government authorities seek to increase the capacity of health systems to respond to COVID-19 while maintaining access to essential health services. Drawing on private sector resources is critical as, in many countries, it is a dominant provider of health
services, including for the poor. One important tool for increasing capacity in this way is contracting. This primer offers a practical introduction to contracting the private sector in support of national COVID-19 responses. Its target audience is policymakers in low and middle-income countries (LMICs) that have, at this time, limited experience of using contracts for health services but are expected to do so in the emergency conditions created by COVID-19.

Opening Session on Sustainable Infrastructure and SDGs for PPPs – 5th Istanbul PPP Week (2 November 2020)

Shortened transcript of the opening Panel on Sustainable Infrastructure and SDGs, 5th Istanbul PPP Week (2 November 2020)

Natalia Korchakova-Heeb: Good morning, ladies and gentlemen! I am happy to greet you at the opening panel of the 5th Istanbul PPP Week dedicated to sustainable infrastructure and Sustainable Development Goals. (SDGs). Let me introduce myself – I am Natalia Korchakova-Heeb, Managing Director of SDG.17 Consulting GmbH, Germany and founder of PPPHealth4All – a global platform to facilitate sustainable and people-centered healthcare PPPs. Today we are very fortunate to have a distinguished panel: well-known experts that don’t really need an introduction.

Let’s me start from the ladies:  I am very pleased to introduce Hulya Pasaogullari, who is Principal Consultant for PPPs, Economics & Finance at IMC Worldwide. Hulya is a former Head of PPP Office within the Turkish Treasury and has a long track of experience in sovereign borrowing and public investments, PPP Advisory, Infrastructure Finance and Governance.

Next speaker is Mark Moseley, who is is Principal of Moseley Infrastructure Advisory Services. He is the former Chief Operating Officer of the G20 Global Infrastructure Hub and a former Lead Lawyer in the World Bank’s Infrastructure Practice Group. It is a special pleasure for me to introduce Mark as he is also a member of the Advisory Board for PPPHealth4All.

Next speaker is Hugues de La Forge, Partner at the Law Firm Fidal, France. He is Head for PPP projects and is in charge of African countries. Hugues has more than 22 years of experience in advising the public and private clients on contract management, disputes and international arbitration. Thanks to all of you for being with us today.

Ladies and gentlemen,

It is very symbolic that our conference is being opened with discussion on sustainable infrastructure- thanks to organisers for giving a priority to this topic.

Sustainable infrastructure is an essential foundation for achieving the Sustainable Development Goals (SDGs) and the objectives of the Paris Agreement. It is not any about building more roads, hospitals, schools – it is about building sustainably by establishing a sustainable life-cycle: sustainable design, sustainable procurement, sustainable financing, sustainable construction, sustainable operation and maintenance and impact assessment. It is also about increased quality, efficiency, innovation of service delivery and meeting all sustainability criteria (social, environmental, institutional, and economic-financial criteria). My first question goes to Mark Moseley:

Mark, during your time with the World Bank and the Global Infrastructure Hub, you worked closely with the G20 in regard to sustainable /quality infrastructure. Can you describe the G20’s approach to sustainability and the achievement of the infrastructure-related SDGs, and could you please also explain us how the G20’s approach relates to other sustainable infrastructure initiatives?

Mark: Thank you, Natalia, for that kind introduction, and thanks also to the organisers of this year’s Istanbul PPP Week for the invitation to join this panel. I had the honour of speaking at the inaugural Istanbul PPP Week in 2015 and it is great to be back at the event – although the extraordinary circumstances of this year have meant that we are not able to enjoy the opportunity to gather in the wonderful city of Istanbul.

Even though all of us have been forced to deal with the immediate impacts of the pandemic, we should not lose our focus on critically important longer-term objectives, such as the achievement of the United Nations Sustainable Development Goals. And, as infrastructure practitioners, we must not abandon our efforts to help achieve the infrastructure -related SDGs, in terms of universal access to basic infrastructure services for both economic infrastructure such as transport, power, water and digital services, as well as social infrastructure such as hospitals and schools. The need for these services remains acute, and we must redouble our efforts to achieve the SDG objectives while recognising the new realities that will arise in the post-pandemic world.

Recently, many infrastructure strategists – including Thomas Barret, Chairperson at OECD Infrastructure Governance Forum in today’s keynote address — have promoted the concept of ‘Building Back Better’. Indeed, I believe that there is some sort of election currently going on in the United States in which the opposition candidate has adopted that idea. But what do we mean by ‘building back better’? I suggest that what the idea should mean is a commitment to pay close attention to the quality of the infrastructure we are building.

And this is what brings me to the G20’s approach to achieving the infrastructure-related SDGs, as raised by Natalia. As Thomas Barrett (OECD) also noted this morning, the G20 has, for the last few years – beginning in 2015 under Turkey’s G20 Presidency – been focusing on the quality of infrastructure investments. This focus ultimately led to the G20 Leaders formally approving, last year, the Principles for Quality Infrastructure Investment, also known as the QII Principles.

But what, exactly, are these QII Principles, and how do they relate to the SDGs?

There are six main QII Principles, as follows:

  • Principle 1 is to Maximise the positive impact of infrastructure to achieve sustainable growth and development. This principle directly incorporates the UN’s 2030 Agenda for Sustainable Development, under which the SDG goals were articulated.
  • Principle 2 is to Raise Economic Efficiency in view of life-cycle cost. This involves taking into account all phases of the life-cycle of an infrastructure project, including planning, construction, operation, maintenance and disposal.
  • Principle 3 calls for the Integration of environmental considerations in infrastructure investments, by taking into account the positive and negative impacts of infrastructure projects on ecosystems, biodiversity, climate, weather and the use of resources.
  • Principle 4 speaks to Building resilience against natural disasters and other risks, and the need to create comprehensive disaster risk management plans which inform the design and operation of key infrastructure facilities. Of course, as Thomas mentioned, Turkey unfortunately knows all about the importance of resilience, as was demonstrated by the recent tragic earthquake near Izmir.
  • Principle 5 is the Integration of Social Considerations in infrastructure investment, and it urges the adoption of policies that provide open access to infrastructure services on a non-discriminatory basis.
  • Finally, Principle 6 addresses the need to Strengthen Infrastructure Governance, in terms of the government institutions and processes that impact on the planning, procurement and management of infrastructure investments.

This last principle is, in my view, particularly important. Very recently, both the World Bank and the IMF have emphasised the relationship between good governance and the efficiency of infrastructure investments. In this regard, I would particularly recommend taking a look at the new book which the IMF produced in September, entitled Well Spent – How Strong Infrastructure Governance Can End Waste in Public Investment, which can be freely downloaded from the IMF’s website.

The important point is that the G20, alongside the United Nations and organisations such as the World Bank and the IMF, is now focusing clearly on the practical problems associated with achieving the infrastructure-related SDGs by 2030 – and this focus is demonstrating the importance of infrastructure quality and infrastructure governance, as key elements in the achievement of the SDG objectives.

Hulya, based on your experience in Turkey plus in various developing countries you have been working with, where do you see the gaps for achieving a better sustainability in the PPP governance, particularly from the public finance and the financiers’ side (i.e. project prioritization, policy alignment, etc)? What needs to be done and where the policies to be re-shaped?  project screening and preparation phase? 

Hulya: I wish to elaborate on what Mark has just presented but in terms of public perspective. Our priority is to understand how sustainability contribute to the the success factors of the public services. Here we are taking about hard/soft infra sectors, the service facilities in investment policies. This all relates to the global development efforts. Politicians and the public authorities are setting the trends and goals of sustainability in their development agenda  and these goals need to be achievable ones.

Considering the project life cycles the critical perspective and the responsibility is in the public side when it comes to the project preparation and the project availability for the private sector. Let me elaborate a bit. When you are working on a country diagnostic study, the first ever thing to understand that country is to look at the high level policy documents.  You will screen the development plans and the high-level investment plans of a country.

The related strategies, goals and targets are all very inter-connected and there is an aim to decrease the existing infra gap with fostering the economic growth with investment. Considering the sectors one by one, I believe we have a new paradigm with the COVID that the priorities have been changed in the public services. I was in Kathmandu (Nepal) last year to support the Investment Authorities for PPP policies. We were drafting the PPP guidelines. The key sectors identified were tourism, energy and transportation when we were discussing the procurement parameters for the candidate airport project. But during COVID pandemic, we start discussing the remote education facilities and healthcare service. This is a remarkable shift in all such discussions. This is the demand side key shift that we face with. The needs are changing.  Coming to the supply side, yes, we know that the public money is limited. Especially now, the resources are more limited with the slowdown in the economy and the urgent budgetary expenditures. This increases the importance of the private sector participation which will also trigger the effective usage of resources including the time  saving!

We need to identify how PPPs may help to close infrastructure gaps and inequalities and seek suggestions from PPP experts to improve:

  • poor planning and project selection: analysis, technology and innovation;
  • inefficient delivery: life cycle management and long-term perspective;
  • limited public resources: private financing.

We need to encourage further discussions on best practices in PPP preparation with the aim of creating a knowledge that could assist governments in doing better PPPs. 

Another consideration: some candidate PPP projects are better in terms of financial viability including the affordability and revenue generation capabilities. However, considering the sustainability and the SDG, there is an increasing demand to showcase the social benefit of the projects.

So, if the key consideration is time (which is more important than money nowadays), the social impact of a project is more critical to highlight the importance of the private sector engagement. All these prioritization shifts also impact the project screening and preparation aspects.

This is also good to see that in the last decade there are plenty of new cases of the ESG -compliant projects and I am sure we will be able to hear more from the speakers in the forthcoming sessions where the real cases and country examples to observe that shift will be demonstrated.

The countries and decision-makers should look at the changing world on how they can integrate better the PPP governance and sustainable development. We have seen plenty of good examples during the last 8 months.

Hulya, where you see the differences in the policies and approaches across the countries related to integration and implementation of the SDG goals within PPP projects? Does it increase the complexity of PPPs? How we can facilitate a better stakeholder engagement in PPPs to foster the implementation of Sustainable Goals?

Hulya: Every country has a different way of doing business, which shapes their the political decision making and even technical valuation and criteria settings.Moreover, it is also very crucial who will hold the flagship of SDGs. It is very clear that the governments and public agencies are the key players in leading SDGs.

Happy to see that the private sector who have more integrations with the public side is  more  and more focusing on the social and development-oriented strategies in their corporate activities.  This is a really good pick for these big scale private sector players having a dominant role which puts people in the centre of all these decisions.

I have been intensively working with the South Asia countries in the last two years and have witnessed that the social benefits and the impact of an infra investment iare very important for the politicians to demonstrate to the public to proof the effective public money spending.  This also relates to the transparency. We observe these sensitivities also in the local level. This also yield an increase in the social infra sectors as top priority in the developing countries.

The key challenge is the local capacity and domestic resources needed both for technical and financial capabilities. The countries who also connect their local development with private sector solutions in terms of domestic mobilization also have a better development impact , especially in mitigating the foreign exchange rate risk and country risks.

Attracting long term investment in private financing is also very crucial for these countries and the

  • tariff regulations,
  • pricing policies,
  • government support tools,
  • creating an enabling environment for the foreign investors like
  • step in rights and arbitration

– are all key elements that require further consideration.

Hugues, you have a lot of practical experience on the ground in Africa, especially with governments and project sponsors. What are the actual trends regarding the inclusion of social impact in infrastructure projects in Africa?

Thank you, Natalia. I would also like to warmly thank the organization of the Istanbul PPP Week for inviting me and especially Dr Eyup Vural Aydin. For sure we would have preferred meeting each other’s in persons and enjoying the view on the Bosporus but for the time being we mainly enjoy our home offices views!

Whereas Africa has been apparently less impacted than others continent by the Covid 19 virus, the current pandemic reveals the weakness of most of African countries as they either depend on importations of goods from outside or rely on exportations of their oil and gas productions. I would like here to remind a few facts:

  • 600 million Africans do not have access to water;
  • the amount of funding needed to achieve the Sustainable Development Goals (SDGs) by 2030 would exceed € 150 billion per year;
  • less affluent and / or isolated social classes are the most affected;
  • investors logically focus on creditworthy and easy-to-serve clients, which excludes the less fortunate and the most landlocked;
  •  Projects affecting a large population – therefore less solvent – are more difficult to finance.

Hence it is urgent to modify the scope of all infrastructure projects to include populations that are less easy to serve, and at the same time finding financial making projects dedicated to make them viable.  

Hugues, could you give us concrete examples on the extent of which infrastructure projects in Africa are modified/adjusted to take into account those social, sustainable and environmental criteria?

Absolutely. The priority list of infrastructures that needs to be addressed is the following :

  • drinking water and sanitation
  • electricity and energy
  • health and education
  • transport and communications

For example :

-a mining train which, although it may find its profitability by its sole mission of evacuating metals or minerals, it can become a structuring axis for entire regions by ensuring passenger trains with adapted (and probably subsidized tariffs) .

– dams are more and more designed to also benefit the surrounding populations, partly as compensation for the nuisance of the building, partly with the consequence of a much greater social acceptability of the entire project.

– off-grid electrical service models are increasingly available, thanks to photovoltaics and mobile phones; the move to a larger scale requires additional capital, and therefore, upstream, studies showing the profitability for the investor, and its conditions. Other specific modes of production or distribution have been developed, in Africa and elsewhere, often thanks to non-profit funding (international aid, NGOs, foundations, CSuR, etc.): shared transport, autonomous management of wells or fountains, multifunctional platforms, subsidized tariffs.

Mark, do you think there is a need to streamline the practices across countries and donors. How should take a lead on that?  Would you please elaborate on this?

Mark: Well, Natalia, your question is a provocative one – because it points to a basic flaw in our system of dealing with international challenges – particularly challenges, like the achievement of the SDGs and the issue of climate change, which require collective action by multiple countries.

Of course, the SDGs are a product of deliberations at the United Nations, and there was a consensus of countries in support of the SDG goals. However, the UN has, historically, struggled to mobilise countries to act on their commitments. In short, it’s fine to agree on aspirational goals, but they are meaningless unless countries actually implement their promises.

Indeed, in response to the long-standing perception that it is very difficult for the United Nations to force countries to honour the commitments which they have made, various states have created other groupings and organisations to take collective action. That was one of the reasons behind the establishment of the G7 Group and, when the G7 was found to be too narrow, a decision was taken to create the G20.

Interestingly, the G20 Group brings together not only advanced economies, but also emerging market countries, such as Indonesia and South Africa. And this gives the G20 a certain ‘moral legitimacy’ in terms of  acting as a coordinating agency. Also, the members of the G20 have significant influence on the boards of directors of the major development organisations, such as the World Bank, the Asian Development Bank, the African Development Bank and their various sister institutions.

Accordingly, I believe that the G20 can and should play a key role in coordinating sustainability practices across countries and onerous – and that is why I wanted to provide some details, in my earlier remarks, on the direction that the G20 is currently taking in regard to quality infrastructure investments.

Natalia Korchakova-Heeb: Thanks a lot for your insights and interesting discussion. Hope we provoked some thinking and inspire our audience to integrate SDGs and make infrastructure projects more sustainable.   Let me close  the session. We wishing our participants a good continuation of the conference.

PPPHealth4All Persona-Dr. Eyup Vural Aydin, Istanbul PPP Center of Excellence

We talked today with Dr. Eyup Vural Aydin,  the Chairman of the Istanbul PPP Center of Excellence and the Chair of Executive Committee of the Istanbul PPP Week since 2015.
 

Dr. Aydin, this year you are organizing  already the 5th Istanbul PPP Week. Could you please tell us more about it?

Annual Istanbul PPP Week will be held on 2-5 November 2020. This year we are going virtual because of Covid-19. It’s a great opportunity to meet the world’s top PPP experts, high-level decision makers, heads of PPP Units, businessmen and representatives of the leading construction companies. The main topic of this year’s event is “Reshape PPP Together: Infrastructure Economy Beyond the Pandemic”.

This year the Istanbul PPP Week is going to be a virtual event.  What are main changes and new formats?

-We will have interactive sessions. Participants will be able to ask questions to the experts and learn more about the PPP projects. One of the features is that we will have special discussion rooms where experts can gather separately from the other participants. Also heads of PPP Units from the entire world will present their project pipelines  and this will be a great chance for private companies to learn about forthcoming opportunities.

What international organizations will be speaking at the conference this year?

Our speakers are from the government authorities of various countries and representatives of the following organizations: Ministry of Trade of Turkey,  Global Infrastructure Facility, EBRD, IsDB, IFC, IMF, OECD Infrastructure forum, GIHub, Meridiam, DEIK, Istanbul PPP COE and many others.

We are inviting all PPP practitioners and experts to this gathering of PPP community. This year at the event, we will start to our new “PPP Talks” project as well.

Interview by Natalia Korchakova-Heeb, Founder PPPHealth4All

 
Istanbul PPP Week has become one of the top PPP events in the world. We are proud to be partners and support this international conference.

develoPPP.de CLASSIC – Development Partnerships With the Private Sector

Project proposals can be submitted between October 1, 2020 and December 31, 2020.

German Federal Ministry for Economic Cooperation and Development (BMZ) could support your company’s innovative projects and commercial investments in developing and emerging-market countries provided that they offer long-term benefits for the local population.

Projects typically cover a wide range of sectors and themes – from training local experts and piloting innovative technologies and demonstration units to protecting value chains and improving manufacturers’ environmental and social standards.

The company is responsible for covering at least half of the overall costs.

At every stage, the company will work with one of the two official partners commissioned by BMZ to implement the programme on its behalf: DEG – Deutsche Investitions- und Entwicklungsgesellschaft mbH and Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH.

The companies could submit their project idea to DEG or GIZ by participating in one of the ideas competitions held four times a year.

Target group
Companies with project ideas that offer potential development benefits and do not simply constitute an investment in their actual core business.

Funding
Between EUR 100,000 and EUR 2 million of public funding on top of your company’s own contribution (≥ 50%)

Criteria
Minimum annual turnover: EUR 800,000
Minimum number of employees: 8
At least two years of audited financial statements

Term
Up to three years

Further information:

COVID-19 hospital in India built under PPP approach

The first dedicated COVID-19 hospital in Kasargod, Kerala, built by the Tata Group, was inaugurated  on 9 September 2020 by Chief Minister Pinarayi Vijayan.  Built by the Tata Group using prefabricated containers in just five months at a cost of Rs 60 crore, the 551 bed hospital has 36 ventilators for the patients.

“The Covid hospital constructed by the Tata group, which will take care of the people during the pandemic, is an excellent example of how Public-Private Partnership can be put to good use” Chief Minister Vijayan said.

The 80,000 sq ft-hospital has been built on five acres of land at Thekkil village in Kasaragod. The authority to decide the facilities and the appointments to the hospital is with the state government.

Source: PTI

Source: Tata Group

 

#PPPsAgainstCorona: Workshop on Public-Private Partnership Responses to COVID-19 and Future Pandemics, the National Academies of Sciences, Engineering, and Medicine (USA) (25-26 June , 2020)

Pandemics, like COVID-19, present unique global health challenges that, by necessity, are catalyzing make-shift and long-term PPPs to remediate unprecedented burdens on the healthcare infrastructure and on morbidity and mortality.

As COVID-19 is now infecting people in countries across the world, the field of global public health is prompted to analyze what PPP-generated global health practices have worked in the past to respond to epidemics and pandemics, and whether or not those response frameworks inform current and future pandemic responses.

The problems pandemics create may be universal (e.g., in terms of pathways to transmission) but also context-specific, as different countries have different capacities to address these challenges, as well as different priorities. As PPPs are now being forged upon the need to respond to COVID-19, there is also an opportunity to define what recent PPP and private sector innovations may serve to inform future handlings of pandemics affecting low-and middle-income countries (LMICs) and high income countries (HICs), as well as what innovations might currently exist in certain global regions that could be transferred to new interventions that may combat COVID-19. Such an analysis may promote information-sharing in live time to combat COVID-19, as well as inform best practices for future outbreaks.

As the world draws closer through the COVID-19 crisis, and those in HICs now face equipment, space, and staffing shortages often seen in LMICs, there is a need to analyze PPP pandemic responses through the larger framework of how they may serve the needs of the global public good, to extend needed support to all countries and people. In a similar vein, the COVID-19 crisis has revealed that PPP responses to pandemics also need to define, adapt, and mechanize a broader global health security agenda that builds global and country-level capacity to address future pandemics.

To explore these topics, this workshop has invited some of the world’s top experts in pandemic response, who will:

(1) review best practices and critical actions from past PPP epidemic and pandemic responses to determine if past response frameworks have applications for the current COVID-19 pandemic;

(2) explore PPP innovations and models that are addressing COVID-19 in country settings;

(3) examine PPP pandemic responses that increase and help navigate the distribution of global public goods; and

(4) discuss PPP pandemic responses that enable the development of a broader global health security agenda.

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$12 Million Public-Private Partnership “Baltimore Health Corps” to Hire and Train Hundreds of Jobless Residents to Serve Neighborhoods Hardest-Hit by Covid-19

 

Innovative pilot PPP program to equitably address Baltimore Public Health and Employment Challenges mobilized by initial $2M commitment by the Rockefeller Foundation (USA). 

Over the course of 12 months, the Baltimore Health Corps will serve three core objectives:

  • Job Creation and Skills Training
  • Controlling the Spread of Covid-19
  • Serving the Social Needs of Baltimore’s most vulnerable.                                                     

The City of Baltimore has made a $4.5 million commitment to support this initiative, tapping into its CARES Act Funds. Additional private funders have contributed more than $2.3 million in support and include the Annie E. Casey Foundation, Bloomberg Philanthropies, CareFirst BlueCross BlueShield (CareFirst), the France-Merrick Foundation, the Goldseker Foundation, OSI – Baltimore, the PepsiCo Foundation, the Rauch Foundation, the Stulman Foundation, and the T. Rowe Price Foundation. The Baltimore City Health Department, Jhpiego, the Mayor’s Office for Employment Development, Baltimore Corps, HealthCare Access Maryland, and the Baltimore Civic Fund are partnering to operate the initiative. The total cost of the initiative is $12.4 million, and the City will continue to raise the remaining $3.5 million as the pilot gets underway.

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Webinar: PPPs in the healthcare and COVID-19

The Infrastructure Concession Regulatory Commission (ICRC) , an agency of the Federal Government of Nigeria responsible for the development and implementation of Public Private Partnership framework for the provision of infrastructure services, has organised a webinar to reflect on impact of  COVID-19 on PPPs,   international experience and how PPPs could be applied to combat COVID-19. The discussion includes Nigerian and international experts from India, Germany, etc. The webinar was moderated by Engr. Chidi K. C. Izuwah, Ag Director General.

Boat clinics PPP project scans remoted islands for COVID-19 in the state of Assam, India


Photo from Jorhat Boat Clinic

Government of Assam (India) partnered with the NGO “Centre for North East Studies and Policy Research ” under the NRHM-Public Private Partnership (PPP) to set up a boat-clinic service which is helping to reach the far-flung areas of the state.  In these districts, the boat clinics are reaching the poor and marginalized population with sustained health care since last two years. The boat clinics provide both preventive and curative care to the population residing in the islands.

“The boat clinics have pitched in to deal with the novel coronavirus disease by carrying out door-to-door community surveillance in the river islands” writes Nabarun Guha.

Under this PPP the operational cost and human resource remuneration are borne by the NRHM, Assam whereas the infrastructure meaning construction of the boats is the responsibility of CNES along with the insurance of the boats. The medicines, vaccines and family planning consumables are supplied from District Health Society. Monitoring mechanism: Under this PPP the partner implementing agency submits monthly action plan and physical & financial progress report to the State. Besides the regular reporting system quarterly review meeting were performed to understand the progress and difficulties arises while implementing the programme.

Progress achieved: The response to the service being provided by the boat clinics for the marginalized population is overwhelming as the community was deprived from the basic health services due to non availability of the health infrastructure. Before the NRHM-PPP these island dwellers had a rare chance to visit health personnel and seek treatment for their illness.  A total of 2,08,203 general health checkups were done and 8,109 pregnant women received the ante-natal checkups, 2,002 women receives post-natal follow-up and 15,818 children were immunized.

More information

Bringing together public and private sectors to lead a mental health and suicide prevention response during COVID-19

Photo by Priscilla Du Preez

Through the Mental Health & Suicide Prevention National Response to COVID-19 (National Response), diverse partners are bringing their best in science, innovation, and leadership to create sustainable and comprehensive solutions to the mental health impacts of this pandemic.

As a national convener, the National Action Alliance for Suicide Prevention (Action Alliance)—the US nation’s public-private partnership—is mobilizing diverse sectors to collectively lead a coordinated mental health and suicide prevention response effort during and in the aftermath of COVID-19.

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