Concept and slogans for communicating health advocacy/tools and materials as it affect health information management

Introduction
Advocacy
in health information manage and health promotion is the active support of an
idea or cause expressed through strategies and methods that influence the
opinions and decisions of people and organisations. In health care management,
promotion and developmental context the aims of advocacy are to create or change
policies, laws, regulations, distribution of resources or other decisions that
affect people’s lives and to ensure that such decisions lead to implementation.

Such
advocacy is generally directed at policy makers including politicians,
government officials and public servants, but also private sector leaders whose
decisions impact upon peoples’ lives, as well as those whose opinions and
actions influence policy makers, such as journalists and the media, development
agencies and large NGOs.
The body
In
carrying out health advocacy, careful planning and a strategic approach are
therefore needed if results are to be achieved. Policy change rarely happens
overnight so effective advocacy requires long-term as well as short-term
thinking, an understanding of the points of resistance and the means to gain
traction, the readiness to form alliances, and the flexibility to seize windows
of opportunity.
Some
of the more commonly used advocacy techniques, from critical engagement such as
policy monitoring and policy dialogue is to highlights the importance for
people facing disadvantage to be able to assert their own needs and interests.
It explains step by step how to devise an effective advocacy strategy for
health care policy reform.   Techniques for effective advocacy
Policy
monitoring and public accountability

Almost all effective policy-related advocacy efforts commence with observation
and monitoring of the implementation and effectiveness of policies already in
place. These might include, for example, commitments to ICT infrastructure
roll-out, universal access policies, support for community-based ICT access
centres, public interest broadcasting policies, or regulatory mechanisms to
ensure fair pricing of services.
High profile ICT policy monitoring by civil society advocacy groups can, on its
own, contribute to improved policy implementation and effectiveness by
highlighting public policy targets and drawing public attention to under
performance or to policy failure. Governments and public bodies, especially in
democratic societies, are sensitive to critical reports, and more so when these
are based on robust evidence and analysis, come from a credible source, and are
widely published and disseminated.
Policy monitoring by civil society groups may be in the form of one-off
investigation into a particular area of interest; it may consist of a baseline
study, perhaps at the commencement of a new policy, and a follow-up study later
to establish what results were achieved; or it may be a periodic monitoring
report, such as an annual review.
Policy monitoring and public accountability are made easier where government
departments and other public bodies, including regulatory organisations,
maintain and publish data and reports in a timely fashion and undertake
research and consultation to facilitate decision making in the public interest.
Where this is not the case, where the information is poor or unreliable, or
where independent data is needed, civil society organisations and coalitions
may organise their own research and data gathering, or they may rely on third
party sources such as commercial and academic research.



Right to information
laws can help and, in countries where such laws are weak or absent, their
adoption or improvement has itself been a key demand of civil society
organisations, not only those working in the communication policy field. In
some cases investigative journalism may be needed to root out and expose policy
failings.
Impact may often be enhanced by involving citizens and civil society
organisations in the process of policy monitoring and review and by gathering
demand-side data using techniques such as citizen surveys, social audits and
participatory policy review. Such social accountability mechanisms have gained
increasing recognition as effective means of strengthening civic engagement in
policy making and policy monitoring.
Policy
dialogue – ICT and mainstream development policy
Policy monitoring
alone may prompt corrections to policy failure or lead to improved policy
implementation, but most civil society groups concerned with ICT policy also
carry their own ideas about what policies are desirable. They are interested in
gaining influence earlier in the policy-making process. At its most
straightforward this involves engagement in policy dialogue with bureaucrats
and politicians.
The Women of Uganda Network (WOUGNET), for example, has a core programme
activity on “gender and ICT policy advocacy” with a focus on equitable access
to ICTs and engendering ICT policy making. Their priorities include not only a
focus on existing ICT policies such as the Rural Communications Development
Fund (a levy applied to telecom providers to support areas that are underserved
by markets) but also engaging in policy development processes such as the
review of the National ICT Policy. WOUGNET participates actively in
government-organised stakeholder consultations on ICT policy, it contributes
its own studies and reports, and it responds to draft policy proposals.
Civil society organisations like WOUGNET, whose field of interest is in the
development of the use of ICTs, tend to focus their policy dialogue efforts on
areas of policy making that are explicitly and primarily concerned with ICT
policy: universal access arrangements, national e-strategies, etc. This may
seem an obvious strategy but, on its own, it can also have the drawback of
limiting policy dialogue to a relatively narrow range of actors – especially
those who already share a similar outlook or others perhaps more interested in
ICT growth than in pro-poor development.
Strategic engagement in policy dialogue on pro-poor ICT access can also be
gained by taking, as a primary focus, areas of mainstream development policy –
education, health, rural livelihoods, and so on – and contributing to more
strategically framed development policy making such as the preparation of
National Development Strategies. This perspective can assist in gaining
traction for a pro-poor ICT access agenda across a broader political and
policy-making spectrum. It can also assist better understanding of the real
world policy choices that politicians and their constituents face – cleaner
water or faster connectivity, more clinics or more ICT access centres – and
better articulation of the role of ICTs in poverty reduction.



For effective
pro-poor ICT policy dialogue, engagement on both fronts may be the most
productive strategy: ensuring that ICT policy making is informed by a pro-poor
perspective and strengthening that position by building support across
government, especially those most engaged with poverty reduction and pro-poor
development.
Campaigns
for policy change
In India, in 1996,
the National Campaign for People’s Right to Information (NCPRI) was founded by
social activists, journalists, lawyers, professionals, retired civil servants
and academics. Its goal was to campaign for a national law facilitating the
right to information. Its first step was to produce, with the Press Council of
India, a draft right to information law. After years of public debate and the
passage in several Indian states of right to information laws, the government
of India passed the Freedom of Information Act 2002. The Act was weakly
drafted, subject to widespread criticism and never brought into force.
Continued campaigning and a change of government led eventually to adoption of
the Right to Information Act 2005.



Civil society
campaigns for policy change rarely achieve rapid results. They require
patience, tenacity, courage and conviction. There is no blueprint for success,
but there are some common denominators to almost all successful advocacy
campaigns. It is essential, for instance, to maintain clarity in
communications: goals should be clear and achievable; messages should be
compelling for those to whom they are intended; calls to action should be
specific and concise. Good planning and organisation must combine with the
ability to mobilise broad coalitions of public and political support towards a
common goal.



Policy campaigning is
goal-oriented advocacy in which civil society groups and coalitions aim to set
the policy agenda rather than simply to monitor or respond to government policy
making. It involves taking action and initiative. It can be exciting and
empowering for those involved, but it can also be hard work, frustrating, and
ultimately unsuccessful. Before adopting a campaigning orientation it is worth
asking whether the goals could be better achieved by dialogue or quiet
negotiation.
Campaigns for policy change draw on a wide range of tools and tactics,
including public demonstrations, protests, letter writing, lobbying, use of
media and the internet, and legal action. Campaigning is often confrontational
in nature. After all, a campaign would not be needed if the government or
private company was receptive to the policies being advocated. Conversely, it
is often the dynamic of conflict that gives a campaign momentum, spurring media
attention and recruiting public support.



Campaigns are often
built in response to particular opportunities or threats arising in the context
of the process of policy change. For example, the transition from analogue to
digital distribution systems for television is moving ahead rapidly worldwide,
with only limited time for civil society organisations to gain guarantees of
access to the new channels. In Uruguay, a law first drafted in 2005 by a
coalition including community broadcasting activists, journalists and labour
unions was adopted in 2007, guaranteeing an equitable distribution of
frequencies between private, public and civil society organisations. The law
has ensured that civil society groups have a legal entitlement to use part of
the digital television spectrum.



In Ecuador, the
process of adopting a new constitution that began in 2007 under the presidency
of Rafael Correa was seen as an opportunity by civil society groups engaged in
media and ICT advocacy to challenge the existing political economy of the
communications environment and to propose a new communication rights framework.
The new constitution adopted in 2008 included the explicit entitlement of all
persons to universal access to information and communication technologies,
together with a right to the creation of social media, including equal access
to radio frequencies.



Some civil society
advocacy organisations may have several campaigns running at the same time,
each with distinct goals requiring different alliances and strategies. In other
cases a single-issue organisation, or a coalition of like-minded groups, may
form to campaign towards a single policy goal, as in the example of India’s
campaign for a right to information law. International campaigning
organisations, such as Amnesty International and Greenpeace, have tested their
campaigning methods over many years. Some of the lessons learned are also
relevant to ICT policy advocacy.
Building
the advocacy capacity of stakeholder groups
As noted in the
introduction to this toolkit, poor people face systemic barriers in their
access to information and in their means to exercise their right to freedom of
expression. The lack of “voice” of disadvantaged groups is a challenge at the
core of pro-poor advocacy on ICT access. It is one of the reasons why advocacy
for equitable access to ICTs is important. At the same time, it compromises the
ability of disadvantaged people themselves to advocate for their own
communication needs.
This is a critical issue that demands the attention of any organisation engaged
in pro-poor ICT advocacy. We stated earlier that “pro-poor advocacy” means
advocacy for political decisions and actions that respond to the interests of
people who directly face poverty and disadvantage. They are the primary
stakeholders. Their lack of voice can be overcome in two distinct ways. As
Drèze and Sen describe it: “One is assertion (or, more precisely,
self-assertion) of the underprivileged through political organisation. The
other is solidarity with the underprivileged on the part of other members of
the society, whose interests and commitments are broadly linked, and who are
often better placed to advance the cause of the disadvantaged by virtue of
their own privileges (e.g., formal education, access to the media, economic
resources, political connections).”



There are a great
number of “pro-poor advocacy” organisations that are not, by any means,
populated by people with first-hand experience of poverty. Rather they are run
by well-educated middle-class professionals for whom pro-poor advocacy is a
vocation. This is as much a reality in the ICT policy field as in other
development sectors. That such people have chosen to work for and in solidarity
with those who face the daily struggle of poverty and deprivation is, of
course, to be welcomed – social solidarity is very often an important component
of advocacy and political action – but, on its own, it is also “a somewhat
undependable basis of authentic representation of the interests of the
underprivileged.” Solidarity has multiple motivations, is not always
accompanied by shared perspectives, and may be more effective at attracting
support when it conforms with dominant ideologies.



Thus building the
advocacy capacity of self-help groups of the disadvantaged and of
community-based and working-class organisations is at least as important as
doing advocacy for the poor. Effective pro-poor advocacy on access to ICTs must
include strategies likely to lead to an increase in the voice and influence of
the underprivileged sections of society in ICT and other policy making. This
may include, for example, strengthening the communications capacity of
disadvantaged people’s organisations and support for development of grassroots
communication initiatives like community radio. Such strategies can be
effective in enabling people who are disadvantaged and marginalised to speak
out directly on the issues that affect their lives and livelihoods.
The Bangladesh NGOs Network for Radio and Communication (BNNRC), for example,
is a national network that combines a programme of advocacy in ICT policy areas
such as right to information, community broadcasting and e-governance, with
practical support for rural knowledge centres and community radio stations.



Deccan Development
Society (DDS) is a grassroots organisation working with women’s sanghams (self-help
groups) in about 75 villages in the Medak District of Andhra Pradesh, India.
The 5,000 women members of the Society are mostly Dalit, the lowest group in
the Indian social hierarchy. As part of a broader strategy in pursuit of
“autonomous communities”, the women of DDS established the DDS Community Media
Trust, including a video production unit and Sangham Radio, the first rural
community radio in India and the first women’s radio in South Asia.



The
right-to-information movement in India drew, among other inspirations, on
empowerment-based approaches to public accountability pioneered by Mazdoor
Kisan Shakti Sangathan (MKSS) in Rajasthan, including public hearings where
accounts, including public expenditure records, were read aloud at
independently organised village meetings and local people were invited to give
testimony.
Pathfinder
and demonstrator projects
New ideas in policy
are not always easy to communicate to those who influence or make decisions,
particularly where they involve new or unfamiliar uses of ICTs. It may not be
until an idea has been demonstrated in action that it is fully understood.
“Pathfinder” or “demonstrator” projects can therefore be an effective
alternative strategy for ICT policy advocacy. If success can be demonstrated in
practice, it can have the dual impact of mobilising further demand and interest
and of motivating policy makers to take decisions that encourage replication
and scaling-up. Such initiatives can be resource intensive. They may require
certain policy decisions before they can proceed, but policy makers may also be
more receptive to allowing a limited experiment to test and demonstrate an idea
than to agreeing a major policy change.



RITS (Rede de
Informacão para o Terceiro Setor) was founded in Brazil in 1997 to strengthen
civil society organisations’ communications capacity. The organisation has
built an impressive network for monitoring ICT policy and campaigning on
equitable access. A demonstrator project organised by RITS in partnership with
Sampa.org led to the establishment of 128 community-based telecentres in São
Paulo, with an estimated half a million users per month. The model offers free
public access and training support, is based on free and open source software,
and promotes community involvement in management and development of the centres
as a space for community organisation. With support from Petrobras, it has been
replicated in 50 locations across Brazil. The Brazilian government is now
considering investment in 10,000 new telecentres drawing substantially on the
experience of the RITS demonstration.



The Nigeria Community
Radio Coalition, launched in 2003, has mobilised broad support for its campaign
goal of seeing community radio services established in Nigeria. As part of its
strategy for opening the door to community radio development, it has proposed a
pilot scheme in at least six locations to be distributed across the country’s
geopolitical zones. The proposal for a pilot scheme has been supported by the
National Broadcasting Commission and by the National Fadama Development
Programme, which has committed funding for preparation and infrastructure.
3.  
 Advocacy planning and implementation
In this part we look
at the practical steps involved in ICT advocacy planning and implementation.
The stages outlined draw on principles of strategic planning and project
management combined with political analysis and communications. For each of the
stages we set out some key considerations to be addressed. At several points we
pose questions rather than solutions. There is no single template for pro-poor
ICT advocacy. The questions are intended to assist the process of planning and
design.
A.  
 Preliminary steps
(i)Identifying
the problems and the policy issues

What is the pro-poor ICT access issue to be addressed? Why is it important and
to whom? This may have been highlighted through research, expressed as a demand
by grassroots organisations, or it may have a normative basis, for example, it
has been identified by comparison with good practice elsewhere. Does this
problem have a policy dimension? What current policies reinforce the problem?
What changes in policies could lead to improvement? Who is responsible for
those policies?
(ii)Defining
the advocacy goal

It can be helpful, at the preliminary stage, to define the goal of the proposed
advocacy initiative. What positive change can be expected to result if the
initiative is successful? Is the initiative intended to improve access to
information, to promote dialogue, or to strengthen voice and influence? Or will
it contribute to all of these things? Or to broader development goals? Who will
be the primary beneficiaries of the initiative?
(iii)Consulting
and building relationships

Building relationships is intrinsic to any successful advocacy effort and
should also commence at an early stage. Before engaging in detailed policy
analysis and planning it can be important to consult with other organisations,
especially those which share similar goals and interests. Has any similar
initiative been tried before? If so, what were the results? Is anything similar
being considered or planned? Are there opportunities to build a
partnership-based approach from the outset?
(iv)Establishing
credibility as an advocate

The credibility of the organisation, partnership or coalition that is
advocating change is likely to be a key factor in its success. Does it have a
mandate to speak on behalf of those who are expected to benefit? Does it have
specialist expertise? Does it have influence with decision makers? What could
be done to strengthen the credibility of the initiative – for example, further
research and consultation, better alliances?
B.  
 Analysing the policy environment
(i)Identifying
relevant policies, laws and regulations

Having decided, in principle, to consider advocacy as a strategy to achieve
pro-poor ICT access and having undertaken some preliminary work to define the
advocacy goals, the next stage involves closer analysis of the policy
environment, starting with an audit of the relevant policies and political
institutions. What policies are already in place (for example, national
e-strategies, e-government, media development, digital divide initiatives)? How
are these reflected, or not, in current laws and regulations? It is important
also to be aware of relevant international treaty obligations, laws and
standards.
(ii)Mapping
relations of power and decision making

Where are policy decisions taken and who has influence over them? For example,
is the focus on government policy and, if so, which ministries and departments
are responsible? What other ministries have an interest in the impact of the
current or proposed policies, for example, rural development, education? Are
there other public bodies with relevant influence or responsibility, such as a
communications regulator or a national media council? What about the
legislature or parliament – are there interest groups in the policy area? Can
support be usefully mobilised across different political parties? Who else has
influence over the key political decision makers?
(iii)Considering
the options for policy change

Would a change in policy alone be sufficient to achieve the advocacy goal? Or
might the proposed policy change also require legal and/or regulatory change?
What about the economic impact – are there taxation or public spending
implications that should be taken into account? Are there alternative
approaches to be considered? Could the goals be achieved incrementally or do
they require a fundamental change in policy? What policy options are most
likely to attract support, or generate opposition?
C.  
 Developing the strategy
(i)Focusing
on the goal and objectives

In developing the strategy, and in the light of more systematic analysis of the
policy environment, it is advisable to return to the advocacy goal and to set
specific and realistic objectives that can be achieved within a reasonable,
defined timeframe. It should be possible at the end of such a period to say
whether or not they were achieved. If the goal is ambitious it may be necessary
to set more limited and incremental objectives – for example, raised awareness,
commitments of support, pilot projects – that can contribute to achieving the
goal over a longer timeframe.
(ii)Identifying
the target audiences

It is useful to distinguish between primary and secondary audiences. The
primary target audiences are the institutions, and the individuals within them,
who have authority to make the policy decisions that are sought. These are
generally determined by the policy goal and objectives. The secondary audiences
are those who are best placed to influence the decision makers. These may
include politicians, public servants, the media, development agencies,
influential NGOs and so on.
(iii)Identifying
allies and opponents

It is important to identify both the potential allies and the likely opponents.
What other organisations share similar goals and concerns? Would they support
the initiative, be open to partnership or to joining a broader coalition? Are
there already coalitions in place? What risks might there be in alliance or
coalition building? What groups or organisations might feel threatened by the
proposals? Could this coalesce into organised opposition? What can be done to
reduce the risk of opposition?
(iv)Selecting
the advocacy approach

What advocacy strategies are most likely to influence the target audiences?
Will it be effective to work through dialogue and negotiation with policy
makers? What is the likely impact of public pressure – can it be expected to
lead to a positive response or to resistance? What sort of treatment can be
expected from the media: supportive, hostile, or indifferent? Are there
incremental strategies that might be more likely to achieve results? Through
what mechanisms might competing interests be brokered?
(v)Identifying
the key messages

In relation to the goal and objectives, what messages are likely to be
persuasive with the primary audience? What about the secondary audience – are
different messages needed for different audiences? If the approach taken is
public or based on a broad coalition, what key messages are likely to mobilise
the broadest support, gain traction in the media, or have a viral effect, with
the audience itself acting as a multiplier?
D.  
 Framing the plan
(i)Preparing
a plan of action

Effective advocacy requires good organisational planning. Having defined the
goal, objectives and strategic approach, it is important to be systematic in
mapping out the actions to be taken to achieve results, including timelines and
milestones. This is best brought together in a logical framework including
measurable progress indicators.
(ii)Budgeting
and identifying resources

Cost considerations are likely to influence the approach to be taken. Policy
monitoring and dialogue, for example, may be achieved with just limited staff
or volunteer time and the means to publicise the results. A media-oriented
advocacy campaign might require substantial publicity costs from the outset:
preparing news releases and placing stories, commissioning photographs or a
video, designing posters and other campaign materials. A capacity-building
project or a demonstrator project might require significant investment in
equipment and training. Organisations working in ICT policy advocacy will
frequently have the skills and know-how to harness new ICTs in their advocacy
work – for example, using email, text messaging and Web 2.0 technologies to
assist with data gathering, coalition building and mobilisation. Funds and
other resources will need to be sufficient to sustain the project for its
duration.
(iii)Risk
assessment

What are the main risks to successful project implementation? Risk analysis
involves assessing the impact of each particular risk and the likelihood of it
happening. It is useful to rate both impact and likelihood (e.g., low, medium,
high). How can the high and medium risks be managed to reduce their impact
and/or likelihood? Particular attention needs to be paid to any risk of harm to
individuals. In many countries, media workers, internet activists and freedom
of expression defenders have faced threats, harassment and violence in the
course of their work. Might the planned advocacy provoke state repression? Are
there non-state actors that pose physical dangers?
E.  
 Implementation
(i)Getting
the message across

Good communications is at the core of effective advocacy. This requires
attention to the message, the audience and the means of delivery. The message
needs to be clear: it should explain what is being proposed, why it is needed,
and what difference it would make. It also needs to be compelling: it should be
crafted to the interests and knowledge of the audience. The means of delivery
must ensure it is received and heard – whether, for example, a written
proposal, face-to-face presentation or public demonstration. It is rare that a
single advocacy message will be received and acted upon. The message needs to
reinforced, by repetition and through the influence of secondary audiences.
(ii)Using
the media

The media – radio, television, press and online media – have a particular role
to play in public advocacy initiatives, especially campaign-based approaches.
Not all advocacy work uses the media, and a media-based approach carries risks
as well as opportunities. The media can bring a mass audience, potentially
increasing profile and credibility, but they can also bring bad publicity and
may contribute to mobilising opposition as well as support. Using the media
requires planning and skills, including building contacts, knowing the media
audience, writing press releases, placing stories, being interviewed, providing
visual imagery and organising newsworthy events.
(iii)Building
partnerships and coalitions

Most advocacy initiatives involve some degree of mobilising public support
behind the proposal. What partnerships and alliances are most likely to assist
in mobilising broad-based support? What processes can best achieve trust,
collective ownership, and effective collaboration? Should the initiative
operate as an open coalition and, if so, what mechanisms are needed to enable
participation and to assure accountability? Is support needed to build the
advocacy capacity of partner organisations? Media and the internet can also be
used to recruit and mobilise broad-based public support.
(iv)Employing
tactics and negotiation

Advocacy is rarely a one-way communications process. Some advocacy work is more
reactive than proactive towards policy makers, or is explicitly dialogical. In
any case, policy and decision makers may well respond to advocacy proposals
with their own questions or alternative proposals. Other interested parties may
launch strategies to counter the proposals being made. It may become necessary
to modify the proposals to achieve results. What alternatives might be
considered? What counter proposals can be expected? What is non-negotiable and
what could be up for discussion?
(v)Monitoring
and evaluation

Throughout the implementation phase it is important to monitor the process, the
results and the policy context. Mechanisms are needed to track activities such
as meetings and communications and to monitor results such as media coverage
and expressions of public support. Data needs to be maintained on the target
audiences: contact details, positions they have taken, offers of assistance and
so on. The process and results should be evaluated not only at the end of the
planned timeframe but on a regular basis so that adjustments, if needed, can be
made to the strategy and plan of action. Advocacy invariably takes place in a
dynamic environment, especially when the focus is on ICTs. The policy terrain
can change for social, political or economic reasons that are independent of
the advocacy initiative underway. The ability to react quickly and flexibly, to
spot windows of opportunity, and to anticipate new challenges requires close
monitoring of the policy context and of broader trends.

4. Case studies
Three case studies
have been provided for this module as well as a list of additional resource
material. The advocacy case studies are outlined below:
Project
Project Description
Highlights
São Paulo Telecentres Project
A successful example of how practical ICT demonstration at a local
level can support national advocacy for policy change
This partnership-based project mobilised policy, investment and
technical support leading to the establishment of 128 community-based telecentres.
It eventually influenced national-level digital-inclusion policies.
Advocacy for community radio in Nigeria
A five-year advocacy project seeking policy change to enable the
establishment of community radio services
This case study
illustrates their approach and the challenges when campaigning for ICT policy
change. It also highlights the lessons learned: for instance, how commitments
to change policy mean little without political will.
Rural Knowledge Centre Movement
The story behind the “Mission 2007: Every Village a Knowledge Centre”
vision that has the goal of extending the benefits of rural ICT access to
600,000 villages in India
This case study documents how a project has evolved into a mass
movement in India and influenced similar initiatives in Asia and Africa, and
has mobilised high-level support from public, private and civil society
organisations.




There are also case studies in other modules of this toolkit which are
particularly relevant to advocacy:
Project
Project Description
Highlights
The Huaral Valley Agrarian Information System, Peru
This project is providing phone and internet access for poor farming
communities and access to an agrarian information system
This case study
illustrates the importance of leadership and vision to ensure that lobbying
and advocacy are undertaken both within communities but also with the
government. The community, through its irrigation board, was able to lobby
for changes in the existing restrictive ICT policy and regulatory frameworks.
 
Nepal Wireless Networking Project
Low-cost and easy-to-maintain wireless networks used in harsh and
remote locations in Nepal to provide phone and internet access to dispersed
and marginalised communities
The advocacy
efforts of the local champion, Mahabir Pun, resulted in the government
changing its restrictive telecoms policies that previously prohibited the use
of wireless networks, while also dropping the costs of licences to under USD
2.
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