H5N1

Effect of economic recession and impact of health and social protection expenditures on adult mortality

Via The Lancet Global Health, an important study: Effect of economic recession and impact of health and social protection expenditures on adult mortality: a longitudinal analysis of 5565 Brazilian municipalities. The summary:

Background 

Economic recession might worsen health in low-income and middle-income countries with precarious job markets and weak social protection systems. Between 2014–16, a major economic crisis occurred in Brazil. We aimed to assess the association between economic recession and adult mortality in Brazil and to ascertain whether health and social welfare programmes in the country had a protective effect against the negative impact of this recession. 

Methods 

In this longitudinal analysis, we obtained data from the Brazilian Ministry of Health, the Brazilian Institute for Geography and Statistics, the Ministry of Social Development and Fight Against Hunger, and the Information System for the Public Budget in Health to assess changes in state unemployment level and mortality among adults (aged ≥15 years) in Brazil between 2012 and 2017. Outcomes were municipal all-cause and cause-specific mortality rates for all adults and across population subgroups stratified by age, sex, and race. 

We used fixed-effect panel regression models with quarterly timepoints to assess the association between recession and changes in mortality. Mortality and unemployment rates were detrended using Hodrick–Prescott filters to assess cyclical variation and control for underlying trends. We tested interactions between unemployment and terciles of municipal social protection and health-care expenditure to assess whether the relationship between unemployment and mortality varied. 

Findings 

Between 2012 and 2017, 7 069 242 deaths were recorded among adults (aged ≥15 years) in 5565 municipalities in Brazil. During this time period, the mean crude municipal adult mortality rate increased by 8·0% from 143·1 deaths per 100 000 in 2012 to 154·5 deaths per 100 000 in 2017. An increase in unemployment rate of 1 percentage-point was associated with a 0·50 increase per 100 000 population per rter (95% CI 0·09–0·91) in all-cause mortality, mainly due to cancer and cardiovascular disease. 

Between 2012 and 2017, higher unemployment accounted for 31 415 excess deaths (95% CI 29 698–33 132). All-cause mortality increased among black or mixed race (pardo) Brazilians (a 0·46 increase [95% CI 0·15–0·80]), men (0·67 [0·22–1·13]), and individuals aged 30–59 years (0·43 [0·16–0·69] per 1 percentage-point increase in the unemployment rate. 

No significant association was identified between unemployment and all-cause mortality for white Brazilian, women, adolescents (aged 15–29 years), or older and retired individuals (aged ≥60 years). In municipalities with high expenditure on health and social protection programmes, no significant increases in recession-related mortality were observed. 

Interpretation 

The Brazilian recession contributed to increases in mortality. However, health and social protection expenditure seemed to mitigate detrimental health effects, especially among vulnerable populations. This evidence provides support for stronger health and social protection systems globally.

Worst global health news of the year

Via the UN, Secretary General António Guterres has published his Remarks to the Fifth Committee of the General Assembly on the Proposed Programme Budget for 2020. Excerpt, with my bolding, and then a comment:

Earlier this year, I proposed measures to resolve the financial crises facing our Organization.  

You have responded positively to some of the proposals for the peacekeeping budget, which will reduce, but not cancel completely, the debt to troop- and police-contributing countries – for which I am grateful.  

But we have not yet addressed the regular budget crisis, and the situation continues to deteriorate. 

This month, we will reach the deepest deficit of the decade. We risk exhausting the closed peacekeeping cash reserves, and entering November without enough cash to cover payrolls. 

This situation would have been much worse if I had not worked since January to curtail spending, align our real vacancy rate with the approved rate, and manage cash on a month-by-month basis. Without these steps, we would not have had, I repeat, we would not have had the liquidity to support the opening of the General Assembly debate and the mandated high-level meetings last month. 

Last week, I was forced to introduce extraordinary measures to cope with the record-level shortage of cash. Vacant posts cannot be filled, travel will be limited to essential travel only, meetings may have to be canceled or deferred, webcasting of non-mandated events will not be available, and support to meetings will have to be adjusted. The Secretariat will no longer be able to support any non-mandated events after 6 p.m. These steps will affect our operations in New York, Geneva, Vienna and Nairobi and at the regional commissions. 

Our work and our reforms are at risk. 

As I introduce the 2020 programme budget proposals, I reiterate my call on you to recommit to paying your financial obligations on time and in full. I thank those Member States that have done so. I also thank those that continue to make every effort to do so, notwithstanding the difficult economic conditions they face. I equally urge you to consider measures to ease the structural impediments preventing us from managing the resources more effectively. 

The full and efficient implementation of our programme of work depends on the financial support of Member States through the adoption of realistic budget levels and the provision of timely contributions to ensure a stable financial situation throughout the year. 

I look forward to your full and enthusiastic support.

This is not just the Ebola response that's running out of money—it's the whole UN. The health consequences scarcely bear thinking about: shelter, food security and basic nutrition and education among refugees, internally displaced people, and disaster survivors; surveillance and response to countless outbreaks around the world; long-term studies of population health. 

You can add to this list. A major factor appears to be the nonpayment of UN dues by the United States, but a quick scan of today's major American media shows little or no mention of the shortfall, let alone the Trump administration's responsibility for it. 

 

The repercussions will be felt all over the world.

Fomeka-Beni mental health center: More than 60 patients in a space designed for 23 people

Via Radio Moto Butembo-Beni, a reminder that not all Ebola casualties actually contract the disease: FOMEKA-BENI mental health center: more than 60 patients in a space designed for 23 people. The Google translation:

Built for a capacity of 23 patients, the Psycho-Clinical and Pastoral University Center FOMEKA-Beni currently has about sixty patients. One room even contains two to three patients for lack of space.  

This concern was presented to Radio Moto Butembo-Beni this Friday, October 4, 2019 by KAMBALE KAHUNDE Jean Louis, psychologist at the FOMEKA-BENI mental health center.  

Monthly, more than 600 people attend this health facility for consultations. Faced with this situation and to save the lives of men, KAMBALE KAHUNDE Jean Louis appealed to the good will to support the psycho-clinical and pastoral center FOMEKA-Beni. 

"I will appeal to anyone of goodwill who listens to me that there is an emergency. Within its means, a partner who may be interested in the war trauma, which may be interested in trauma related to Ebola virus disease in any case it would be nice to try to help a little community," he said. 

Despite the proximity that is observed in this mental health institution because of the lack of space, the psychologist KAMBALE KAHUNDE Jean Louis is pleased that no case of Ebola virus disease has ever been recorded in this center of care since the outbreak of this epidemic in the Beni region. 

"Since the epidemic began, we are meeting the minimum of standard measures. Which means that as I speak, there has never been a case that has been recorded at our center, and that would have come out positive. So, whatever the behavior of our patients, we really try to respect the rules of hygiene," he said.  

It should be noted that some of the mentally ill persons currently in the Fomeka-Beni Mental Health Center have contracted mental illness because of the war in the Beni region. The others became ill after taking drugs.

Hong Kong: Protests affect delivery of health services

Via the Centre for Health Protection, an October 4 statement: DH announcement on service of dental clinics and chest clinics.

In light of possible mass gathering activities in some areas today (October 4), the Department of Health (DH) announced that the evening dental services of Wan Chai Dental Clinic, Yau Ma Tei Dental Clinic, Sheung Kwai Chung Government Dental Clinic and Pamela Youde Government Dental Clinic in Sha Tin have been suspended today.       

Meanwhile, the treatment service hours of DH‘s evening chest clinics have been suspended earlier at 6.30pm today. The concerned clinics are namely East Kowloon Chest Clinic, Kowloon Chest Clinic, Sai Ying Pun Chest Clinic, Shaukeiwan Chest Clinic, Shek Kip Mei Chest Clinic, South Kwai Chung Chest Clinic, Wanchai Chest Clinic, Yan Oi Chest Clinic, Yaumatei Chest Clinic, Yuen Chau Kok Chest Clinic and Yung Fung Shee Chest Clinic. 

Those with appointments will be given a new appointment.

Another statement advises that methadone clinics were to close early because of "mass gathering activities."

DRC Ebola: CMRE update, October 3

CMRE has published Situation épidémiologique Ebola au 03 Octobre 2019. Excerpt from the Google translation:

EVOLUTION OF THE EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI AS OF 02 OCTOBER 2019     

Thursday, October 03, 2019   

Since the beginning of the epidemic, the cumulative number of cases is 3,198, of which 3,084 are confirmed and 114 are probable. In total, there were 2,137 deaths (2023 confirmed and 114 probable) and 995 people healed. 

• 427 suspected cases under investigation; 

• 1 new case confirmed in Ituri in Mandima; 

• 1 new confirmed death in North Kivu in Mabalako; 

• 1 person cured out of the CTE in North Kivu in Butembo; 

• No health workers are among the newly confirmed cases. The cumulative number of confirmed/probable cases among health workers is 161 (5% of all confirmed/probable cases), including 41 deaths. 

• 17th day without response activities in the health area Lwemba to Mandima in Ituri.

The data presented in this table are subject to change after extensive investigation and after redistribution of cases and deaths in their respective health areas.

NEWS  

Prime Minister ready to implement the commitments of the Head of State through the ST/CMRE 

- Prime Minister Sylvester Ilunga Ilukamba considers that the commitments of the Head of State, President Félix-Antoine Tshisekedi Tshilombo, recalled from the top of the United Nations platform, are relayed on the ground by the effectiveness of leadership and Coordination of the Government of the Democratic Republic of the Congo through the multisectoral Committee technical Secretariat of the response to the epidemic in the Ebola virus disease (ST/CMRE) in the response against this 10th epidemic; 

- He said it during a meeting he chaired this Thursday, October 03, 2019 with the ST/CMRE delegation led by his Technical Secretary Prof. Jean-Jacques Muyembe Tamfum who was accompanied by Dr. Kebela and Prof. Michel Kaswa; 

- From this meeting, we note that as early as next week, the Prime Minister will bring together the ministers of Health, Budget and Finance to support the interventions of the response; 

- To this end, he stressed that the multisectoral vision of the response is, at the same time, to put an end to the Ebola Virus Disease and to respond to the security and socio-economic needs of the populations hit by this epidemic;

- He promised that his government will support the approach of the Technical Secretariat of the CMRE to work for the Strengthening of the whole health system of the DRC; 

- Since July 20, 2019, the Head of State, the President of the Republic Félix-Antoine Tshisekedi Tshilombo, is coordinating the response to the epidemic to the Ebola virus disease and has decided to entrust the responsibility of the Technical Secretariat of the Multisectoral Committee to a team of experts under the direction of Professor Jean-Jasques Muyembe Tamfum; 

- The mission of the technical secretariat is to put in place all innovative measures that are urgent and indispensable for the rapid control of the epidemic. 

VACCINATION  

- Preparation of the Vitamin A Polio Immunization Campaign and Mebendazole Deworming in the 17 health zones of the Butembo Antenna, an area affected by Ebola Virus Disease; 

- 17 days already without opening rings around 5 confirmed cases in the Lwemba health area in Mandima in Ituri due to interethnic conflicts and insecurities. 

- An expanded vaccination ring was opened around the confirmed case of September 30, 2019 in Biakatp health area in Mandima in Ituri after dialogues and sensitizations carried out by the communication and psycho-social subcommittees; 

- Since vaccination began on 8 August 2018,   232,160 people have been vaccinated; 

The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 20 May 2018. 

MONITORING AT ENTRY POINTS  

- A FONER Komanda checkpoint provider (PoC) was abducted on Wednesday 02 October 2019 by unidentified men who released him 75 km from the PoC. This provider of surveillance at the Control Points has already resumed its daily services; 

- Since the beginning of the epidemic, the cumulative number of travelers checked (temperature measurement ) at the sanitary control points is 101,714,685; 

- To date, a total of 111 entry points (PoE) and sanitary control points (PoCs) have been set up in the provinces of North Kivu and Ituri to protect the country's major cities and prevent the spread of the epidemic in neighboring countries.

Luke Kane: Ebola is a symptom of dysfunctional healthcare systems

Via The BMJ, an important post: Luke Kane: Ebola is a symptom of dysfunctional healthcare systems. Dr. Kane worked in Sierra Leone during the West African outbreak.

More than one year into the Ebola epidemic in the Democratic Republic of Congo, Luke Kane expresses his disappointment that we’ve failed to learn from past mistakes 

It was 2015, the height of the west Africa Ebola epidemic, and I was waiting for the first patient to be discharged since I’d arrived at the Moyamba Ebola Treatment Centre in Sierra Leone. After her final chlorine disinfection, known as a “happy shower,” she shuffled out of the tent and squinted in the brightness. Doctors and nurses sung and danced around her.  

We all shook her hand—my first human touch without the barrier of personal protective equipment since leaving the UK and her first in weeks. She quietly sobbed with a lost look on her face. She didn’t dance or sing.   

To an outside observer her sorrow might have seemed at odds with the celebratory atmosphere. Why did she look so sad? She was an Ebola survivor, after all. Yet I knew from helping to care for her over the past few weeks that she’d come in with her husband and nephew. Her husband died in pain next to her. Her nephew died across the tent from her. The week before they got to the clinic she’d buried her sister, her mother, and father. She was going back to nothing.  

Four years later, the Ebola epidemic in west Africa is thankfully over but we are now more than a year into the outbreak in the Democratic Republic of Congo (DRC). Despite the new tools at our disposal—vaccines and antibody treatments that we dreamt about having in Sierra Leone—the global medical community is failing the people of the DRC.   

The number of new cases coming from people who were previously unknown to contact tracers remains high. This is the hidden epidemic of Ebola. It’s impossible to vaccinate people who are unknown to the healthcare system. Distrust remains high and suspicions about treatment centres rife. This was also seen in the west African outbreak. In our centre in Moyamba, Sierra Leone, the mortality rate was more than 60%. Why would you willingly enter our treatment centre if most of your friends and family who’d been there before you died? In the DRC outbreak, these suspicions have sown the seeds of violent attacks targeted at Ebola treatment centres and health workers, which have led to increased rates of Ebola virus transmission.   

How did we let this happen? The DRC outbreak started in May 2018. When the first family affected in the outbreak started to display signs of haemorrhagic fever, local healthcare workers were on strike as the DRC government had stopped paying their salaries. The country’s unstable security situation further contributed to the delays in reporting and has led to accelerated transmission of the Ebola virus. The DRC’s healthcare system, already under strain from lack of finances and ongoing armed conflict in the region, has seen Ebola sneak in.    

We need to change how we see an outbreak of Ebola. As a zoonosis endemic across central Africa, sporadic infections of Ebola will, unfortunately, always occur but an uncontrolled outbreak needs to be seen as a symptom of dysfunctional healthcare systems. 

That some of the poorest countries in the world lack functional healthcare systems isn’t news to any of us. The massive global Ebola response effort in the 2013-16 west African outbreak was a chance for the global health community to see how interconnected our various national health systems really are, but this understanding has only been partly realised. 

The West was stirred to action with the Ebola epidemic in 2014 when it threatened to spread beyond the borders of west Africa. Yet if we want to prevent Ebola cases evolving into wider outbreaks, then we’ll need to move beyond reactionary responses and address the factors that pave the way for epidemics.  

These wider realities were illustrated to me back in 2015 when I visited a local community hospital during a break from ward rounds in the Ebola treatment centre. I saw a child with end stage tetanus dying on the floor. The only healthcare worker present was upset as the woman they had operated on the night before had died on the operating table; complications during a caesarean section were above their skill levels. There was no money for electricity, basic medicine, or running water. Everything had gone into the fight against Ebola. 

This neglect of the wider healthcare system and the strains it’s under is happening in the DRC now. Over the summer, for example, the country has seen the spread of a measles outbreak, which has infected more than 165 000 people since the start of 2019.  

As important as the current Ebola response is, we desperately need to focus on investing and developing health systems in Africa. Without strengthening these systems, we will never get out of a cycle in which new outbreaks occur. Working alongside my Sierra Leonean colleagues was an honour and privilege. It was embarrassing to think that if I developed a fever I would probably be evacuated back to London by the RAF to receive the best possible standard of care. 

In contrast, my Sierra Leonean colleagues would be admitted to a local Ebola clinic with a 40% chance of survival. These workers are a huge asset to their local community but are in desperate need of more support and training. Where has the funding been for expanding health training in west and central Africa?   

To prevent future outbreaks, and to support the health of local communities in the poorest parts of the world, we need to invest in strengthening primary care and medical education. Otherwise, we will be here again in another five years, once again having failed to learn from our mistakes. 

South Kivu: Water shortage at Kalehe hospital

Via 7sur7.cd: South Kivu / Water shortage at Kalehe hospital: MPs urge government to find a solution. The Google translation:

Fearing the outbreak of epidemics due to lack of water in Kalehe hospital (South Kivu), the rapporteur of the Provincial Assembly, Jacques Kamanda challenges the government and invites it to find a solution. 

Jacques Kamanda said that the absence of water is increasingly exposing the health of the population and especially the patients interned in health centers and particularly at the Kalehe Reference General Hospital. 

"It's hard to imagine having a hospital without water, it's putting the lives of the patients at risk, and we call on the authorities to implement their campaign promises so that the people of Kalehe will also find themselves in their right of access. water," he said. 

It is worth remembering that this water shortage has hit the Kalehe territory and especially the Kalehe / Ihusi general hospital for more than six months now.

DRC Ebola: Living from paycheque to paycheque

WHO has published its September 12 weekly update: Ebola virus disease – Democratic Republic of the Congo. Excerpts, with my bolding, and then a comment:

Ebola virus disease (EVD) transmission in the Democratic Republic of the Congo continued to ease this past week, with 40 new confirmed cases reported in North Kivu and Ituri provinces; this is the lowest weekly incidence since March 2019. While these signs are promising, it remains too soon to tell if this trend will persist. Emerging hotspots continue to pose challenges in terms of accessibility, insecurity, and violence. Surveillance indicators highlight that public health risks of further spread remain very high. 

During the past 21 days (from 21 August through 10 September 2019), a total of 157 confirmed cases were reported form 15 health zones (Table 1, Figure 2), with the majority coming from the health zones of Kalunguta (19%, n=30), Beni (18%, n=28), Mambasa (16%, n=25), and Mandima (13%, n=20). Alimbongo, Oicha, and Pinga health zones recently passed 21 days without a new confirmed case of EVD. 

As of 10 September, a total of 3091 EVD cases were reported, including 2980 confirmed and 111 probable cases, of which 2074 cases died (overall case fatality ratio 67%). Of the total confirmed and probable cases, 56% (1737) were female, 29% (886) were children aged less than 18 years, and 5% (157) were health workers. 

Under Pillar 1 of the current Strategic Response Plan, the estimated funding requirement for all partners for the period July to December 2019 is US$ 287 million, including US$ 120-140 million for WHO. As of 12 September 2019, US$ 54.9 million have been received by WHO, with further funds committed or pledged. Currently available funds will close the financing gap up until the end of September 2019. Further resources are needed to fund the response through to December 2019, and WHO is appealing to donors to provide generous support.

...

WHO risk assessment

WHO continuously monitors changes to the epidemiological situation and context of the outbreak to ensure that support to the response is adapted to the evolving circumstances. The last assessment, carried out on 5 August 2019, concluded that the national and regional risk levels remain very high, while global risk levels remain low.

Although there are possible early signs of the outbreak easing, including the decrease in numbers of new confirmed cases in Beni and Mandima, these must be interpreted with caution and it is too soon to know if this is an indication of a decrease in transmission intensity of EVD. The high proportion of community deaths, relatively low proportion of new cases who were known contacts under surveillance, existence of transmission chains linked to possible nosocomial infection, persistent delays in detection and isolation of cases, and challenges in accessing some communities due to insecurity and pockets of community reticence are all factors increasing the likelihood of further chains of transmission in affected communities.

The factors mentioned above, coupled with high rates of population movement from outbreak-affected areas to other parts of the Democratic Republic of the Congo, and across porous borders to neighbouring countries, increase the risk of geographical spread – both within the Democratic Republic of the Congo and to neighbouring countries. Conversely, substantive operational readiness and preparedness activities in a number of neighbouring countries have increased capacity to rapidly detect cases and mitigate local spread. These efforts must continue to be scaled-up and sustained.

So WHO's cheques will start bouncing in a little over two weeks, and no one seems upset about it.

You'd think that the African Union, or at least the governments of Uganda, Rwanda, et al. would be raising hell about having to fight a disastrous outbreak on the "generous support" of donors. It's tough enough for ordinary individuals to live paycheque to paycheque, and just a few hundred bucks or euros from disaster. It's absurd to expect international health agencies to do the same—especially when their workers run the risk not just of infection but of being shot dead.

When the rest of the world did its considerable best to ignore Ebola in West Africa, MSF, at least, stood up and chewed out the politicians: if they wouldn't do the right thing out of human decency, MSF was ready to embarrass them into a semblance of good behaviour. We need someone to do the same thing this time.

Population-level surveillance of antibiotic resistance in Escherichia coli through sewage analysis

Today my wife and I had the pleasure of a quick tour of ECDC's headquarters in Solna. The previous HQ, an old building on the campus of the Karolinska, had a lot of charm but wasn't up to the needs of a modern health agency.

Credit: ECDC

 

ECDC moved into its new digs about a year and a half ago, farther out in Solna, a Stockholm suburb. The building features offices and meeting rooms built around a six-storey atrium; the view from the cafeteria on the top floor is a panorama of Stockholm.

Credit: ECDC

 

Most impressive was the Emergency Operations Centre, where ECDC's Epidemic Intelligence Division works and everyone gathers at 11:30 a.m. for an update on the current situation—dominated, of course, by Ebola (one of the clocks on the wall is set to Kinshasa time).

Credit: ECDC

 

ECDC also publishes Eurosurveillance, a weekly journal of studies into current and potential threats to European public health. Here's an example from today's issue: Population-level surveillance of antibiotic resistance in Escherichia coli through sewage analysis. The abstract:

Introduction 

The occurrence of antibiotic resistance in faecal bacteria in sewage is likely to reflect the current local clinical resistance situation. Aim This observational study investigated the relationship between Escherichia coli resistance rates in sewage and clinical samples representing the same human populations. 

Methods 

E. coli were isolated from eight hospital (n = 721 isolates) and six municipal (n = 531 isolates) sewage samples, over 1 year in Gothenburg, Sweden. An inexpensive broth screening method was validated against disk diffusion and applied to determine resistance against 11 antibiotics in sewage isolates. Resistance data on E. coli isolated from clinical samples from corresponding local hospital and primary care patients were collected during the same year and compared with those of the sewage isolates by linear regression. 

Results 

E. coli resistance rates derived from hospital sewage and hospital patients strongly correlated (r2 = 0.95 for urine and 0.89 for blood samples), as did resistance rates in E. coli from municipal sewage and primary care urine samples (r2 = 0.82). Resistance rates in hospital sewage isolates were close to those in hospital clinical isolates while resistance rates in municipal sewage isolates were about half of those measured in primary care isolates. Resistance rates in municipal sewage isolates were more stable between sampling occasions than those from hospital sewage. 

Conclusion 

Our findings provide support for development of a low-cost, sewage-based surveillance system for antibiotic resistance in E. coli, which could complement current monitoring systems and provide clinically relevant antibiotic resistance data for countries and regions where surveillance is lacking.

DRC: The three priorities of the new Minister of Public Health

Since Dr Muyembe took over the Ebola response, we've heard very little about the Ministry of Public Health—in part because it's taken months for the new president to form a government. Via Digitalcongo.net: DRC: the three priorities of the new Minister of Public Health. The Google translation:

The new Minister of Public Health, Eteni Longondo, occupied his offices in the government building on Monday 9 September. 

The new Minister of Health who swears by change and has three major priorities in this sector with multiple challenges.  

One: Strengthen the health system and its administration. This could facilitate the continuation of the work.  

Two: to cope with several epidemics currently raging in the country. In addition to Ebola, which in one year has killed more than 1,800 people, according to official data, measles is also raging in the country. It has already caused twice as many victims as Ebola. There is also polio, the permanent enemy of the DRC.  

Three: improving governance. Eteni Longondo wants to put order in the procurement circuit, imposing transparency. "We want to restore better collaboration with health partners. May they regain lost trust," he says. 

Mastering the physician workforce is also his concern. "It is unfair that those who work get paid for fictitious names."   

A trained and career doctor, the new minister declares the end of business in this sector, which makes health care conditional on money, without worrying about bringing first aid to the patient.  

"Man is at the center of everything. We will manage differently. That the Congolese support this government led by Prime Minister Ilunga. Together, we will work to improve the health of Congolese according to the vision of the President of the Republic," he promised.  

Eteni Longondo, 54, comes from the Union for Democracy and Social Progress (UDPS), where he served as Deputy Secretary General for Finance and Logistics.