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Khet Raj Dahal et al Int. Journal of Engineering Research and Applications www.ijera.com ISSN : 2248-9622, Vol. 4, Issue 8( Version 7), August 2014, pp.118-128

RESEARCH ARTICLE OPEN ACCESS

Sanitation Coverage And Impact Of Open Free (ODF) Zone With Special Reference To Nepal: A Review

Khet Raj Dahal1*, Bikash Adhikari 1 and Jyoti Tamang2 1Ph.D. Scholar of Kathmandu University, Nepal 2Department of Supply and , Kathmandu, Nepal

Abstract The of people such as safe , improved and must be fulfilled for a dignified of human being. Sanitation is one of the major components which directly impact the living standard of people. However, people in many parts of the world have not got the sanitized condition and have been living in a non-hygienic situation. About 35% (2.5 billion) populations in the world are still lacking to access . There are many indicators of sanitized society but is considered as one of the important ones. In Nepal, around 62% have got the facility of toilet. This indicates that 38 % of households have no access to and defecate openly. As a result people have got poor hygiene and sanitation environment. In turn, the country has got the loss of NRs. 10 billion annually. The objective of this paper is to explore the knowledge on (OD). OD is being eradicated from many parts of the world. Many western countries have already been free from OD. But this problem still exists in most of the developing and under-developed countries like Nepal. Though the adverse impact of OD is very high; people are not aware. Construction of toilets by providing outside support for the ultra poor people is not the rational way of eradication of OD. Technical and financial support for toilet construction could be effective if people are aware. Key words: Sanitation, open defecation, Terai, Mountain, Nepal

1. INTRODUCTION Target 7B: Reduce loss, achieving, by The Millennium Development Goals (MDGs) 2010, a significant reduction in the rate of loss. It are international development goals that were includes: established following the Millennium Summit of  Proportion of area covered by the in 2000, following the adoption of  CO2 emissions, total, per capita and per $1 GDP the United Nations Millennium Declaration. All 189 (PPP) United Nations member states at the time (there are  Consumption of -depleting substances 193 currently) and at least 23 international  Proportion of fish stocks within safe biological organizations committed to achieve the following limits Millennium Development Goals by 2015 (Bartram,  Proportion of total water used 2013).  Proportion of terrestrial and marine areas (I) To eradicate extreme and hunger protected (II) To achieve universal primary education  Proportion of species threatened with extinction (III) To promote gender equality and empower Target 7C: Halve, by 2015, the proportion of the women population without sustainable access to safe (IV) To reduce drinking water and basic sanitation (V) To improve  Proportion of population with sustainable access (VI) To combat HIV/AIDS, malaria, and other to an , urban and rural  Proportion of urban population with access (VII) To ensure environmental to improved sanitation (WHO and UNICEF (VIII)To develop a global partnership for progress Report, 2012) development This paper focuses on opportunities and Under Goal (VII): Ensure environmental challenges on achieving the Goal VII, Target 7 C. sustainability following targets was made: Sanitation is defined as “all activities which Target 7A: Integrate the principles of sustainable improve and sustain hygiene in order to raise the development into country’s policies and programs; quality of life and the health of an individual (WHO reverse loss of environmental resources and UNICEF, 2004)”. Generally it includes: appropriate methods of disposal of human excreta,

www.ijera.com 118 | P a g e Khet Raj Dahal et al Int. Journal of Engineering Research and Applications www.ijera.com ISSN : 2248-9622, Vol. 4, Issue 8( Version 7), August 2014, pp.118-128 personal hygiene, hygiene, appropriate National Planning Commission (NPC, 2012) handling, storage, and use of drinking water, prepared a document of Millennium Development appropriate solid, liquid and animal disposal. Goal (MDG) focusing on sanitation facilities in the However, the results of sanitation programme could country. Actually, it is a framework developed by the not be achieved without people’s participation with NPC to accelerate or speed up the pace of the related feeling of ownership from local level. Thus, things to find out new ways which can support to government of Nepal thought to launch rural water achieve 100% national goal on sanitation by 2017. supply and sanitation programme for all people of This means by the end of 2017, the country will have Nepal with the aim of providing sanitation facilities been in a status of ODF (NPC, 2012). all over the country by 2017 (GoN, 2004). Later on The basic needs of people such as safe water, the National Water Plan Policy came into in improved hygiene and sanitation must be fulfilled for existence and it also focused on sanitation program in a dignified life of human being (Devkota, 2011). Nepal. The district should be selected for sanitation However, people in many parts of the world have not programme according to Human Development Index got the sanitized condition and have been living in a (HDI) along with the demand driven approach non-hygienic condition. About 35% (2.5billion) (WECS, 2005). populations in the world lack access to improved Many other attempts were made for the sanitation (WHO and UNICEF, 2004). It indicates improvement of sanitation status in Nepal. However, that there is not the sanitized situation for all in the the situation of sanitation remained unimproved in world. The poor sanitation condition causes diseases urban areas of Nepal. Then government of Nepal such as , , , , enforced the Urban and Sanitation worms, and , which are the barriers to Policy-2009 (Sah, 2013). The policy has the improve the livelihood and living standards of the objectives such as, to ensure the availability of basic, people in the developing and under-developed accessible and adequate water supply, to protect, countries (Sah, 2013). harness, develop and manage surface and ground There are many indicators of sanitation but toilet water services, to promote public private partnership is considered as one of the important ones. In Nepal, in water supply and sanitation services delivery, etc. only 62% households have got the facility of toilet Despite the above attempts, the sanitation situation in (CBS, 2011). This indicates that 38 % of households Nepal is still poor and unsatisfactory. The main have no access to toilets and they compel to defecate problem of not achieving the goals on sanitation openly. Consequently, people have got poor hygiene sector were: less priority was given in this sector by and sanitation environment. In turn, the country has the government and the other agencies, lack of got the loss of NRs. 10 billion annually (Neupane, investment in this sector, fragmented approaches of 2001). Thus, the country’s national target is to investment in the sanitation sector, lack of achieve total sanitation through the use of toilets by disadvantaged and marginalized group participation, the year 2017 (SHMP, 2011). There are 5.427 local administrative bodies were not mainstreamed in million households in Nepal and 2069430 numbers of the sanitation sector, need of higher cost and level of toilets are yet to be constructed in the country (CBS, for urban sanitation, and lack of political 2011). This is a large number and challenging to commitment for the sanitation sector, etc. construct within a given timeframe. Thus, it would be (SHMP,2011). better to build the toilets through social mobilization The Sanitation and Hygiene Master Plan at a cheap rate (Sah, 2013). (SHMP) was felt necessary in order to accelerate the \Poor sanitation causes poor health. Especially, pace of the progress along with the objectives such as women, adolescent girls and infants suffer from the synergize the efforts, generate and maximize local poor sanitation. As a result of poor sanitation, acute resources, reduce the gap between access to drinking respiratory infections (ARI) spread among children water and sanitation, provide guidance to achieve of age under five (MoHP, 2006). Generally human national goal, support to mainstream the concept of faeces are the main sources of ARI. “One gram of total sanitation into national development agenda, human can contain 10 million viruses and 1 support to national commitments South Asian million of ” (GoN, 2000; cited in Sah 2013). Conferences, etc. (GoN, 2011; Sah, 2013). The Thus, there is a need of movement for toilet guiding principles of SHMP were: ODF as the construction in Nepal. Government of Nepal realized bottom line, universal access to toilet in water supply this fact and started a movement of ODF throughout project, technology of toilet the country. The programme has become popular; (permanent/temporary), mainstreaming of local schools, households, local administrative bodies (i.e. bodies, universe of program intervention, user’s VDC, Municipalities, and DDCs) have accepted the friendly facilities in institutions, mandatory provision concept of ODF. And, the rate of ODF declaration is of toilets in new residents/offices (SHMP, 2011). increasing day to day. According to the Sanitation and Hygiene Master Plan (SHMP, 2011), open

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defecation free zone can be declared if following DWSS/ESDMS, 2013). Though there are many conditions are fulfilled: institutions and local administrative bodies which  Every household of a village development have already been declared ODF, there is a question committee (VDC), Municipality or a whole of sustainability. The problems are of diverse in district should have an access to improved toilet, nature. Some of the problems are: management,  There should not be seen any sign of human awareness and post ODF programmes in the area excreta openly in the declared zone, and (Sah, 2013). Similarly, lack of technical supports and  Public and private institutions such as schools, use of construction techniques, lack of proper , government and private offices must planning and implementation and poor behavioral have toilet facilities. attitude (i.e. defecating at open places and negligence Declaration of ODF is followed as the request of of proper sanitation habit) are major management VDC, municipality or a district. If a VDC level water related problems for sustainability (Devkota, 2011). supply, sanitation and hygiene co-ordination Devkota (2011) conducted a study on “Open committee (V-WASH-CC) requests for declaration of Defecation Free Situation” in Nepal. He found that ODF, district water supply, sanitation and hygiene only 92% households used toilets. Out of 92%, 14% co-ordination committee (D-WASH-CC) manages to households had partially functional toilets and 3 % monitor the situation of VDC against the above had non-functional toilets. The study showed that conditions. If a municipality requests for declaration only three quarters of the households had fully of ODF through municipality level water supply, functional toilets (Devkota, 2011; Sah, 2013). Thus, sanitation and hygiene (M-WASH-CC), district water there is a big question of sustainability of ODF in the supply, sanitation and hygiene co-ordination context of Nepal. There are some stories of failure of committee (D-WASH-CC) manages to monitor the ODF in Nepal. Toli and Pandusen VDCs of Bajura situation of VDC against the above conditions. district were declared ODF but could not maintain Similarly, if a district requests for declaration of ODF minimum requirement of post ODF situation. Then, through district water supply, sanitation and hygiene ultimately the District Water Supply, Sanitation and co-ordination committee (D-WASH-CC), regional Hygiene Co-ordination Committee (D-WASH-CC) water supply, sanitation and hygiene co-ordination reverted the decision (DWSS/ESDMS, 2013). committee (R-WASH-CC) manages to monitor the situation of VDC against the above conditions (GoN, 2. SANITATION COVERAGE IN NEPAL 2011). In the past (especially before 1980), there was no According to the government records, Ekata record keeping system of sanitation coverage in Chowk of Morang district is the first settlement of Nepal. But it was found a rough calculation of Nepal declared ODF in October, 2004; Panch sanitation coverage as 2% in national level. It was primary school of Kapilvastu is the first school assumed that the sanitation coverage was more in declared ODF in 2005; Pragatinagar VDC is the first urban areas than in Terai, hills and mountainous VDC declared ODF on May 11, 2007; Dharan of regions of Nepal (Sah, 2013). Area-wise records of Sunsari and Ratnagar of Chitwan were the first two sanitation coverage in Nepal are presented in Table 1. municipalities declared ODF in the same day of The data indicates the percentage of households March 23, 2011. Similarly, Kaski is the first district having toilet facilities. declared ODF on June 24, 2011(Sah, 2013,

Table 1: Area-wise records of sanitation coverage in Nepal Area Year Remarks 1980 1990 2000 2005 2010 2011 2015 2017 2017 is the national Urban - 34% 80 % 81% 78 % 91% 67 % 100% target for declaration Rural - 30% 25% 30% 37 % 55% 52% 100% of ODF throughout National 2% 6 % 30% 39% 43 % 62% 53% 100% the country. Source: GoN/NPC, 2010.

According to the development regions of Nepal, the use of toilet is different. The region-wise scenario of sanitation coverage of Nepal is presented in Table 2.

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Table 2: Region-wise sanitation coverage in Nepal Development Region Households having toilets (%) Far western development region 47.30 Mid western development region 51.40 western development region 73.00 Central development region 63.90 Eastern development region 60.30 Source: CBS, 2011.

Similarly, sanitation coverage in mountain, hill 3. SANITATION PRACTICE IN NEPAL and Terai is 60.10 %, 75.10%, and 48.80 % Generally, in rural areas of Nepal, household respectively (CBS, 2011). There can be many toilets are being constructed on the basis of low cost diseases due to poor sanitation but in Nepal diarrhea technology. Among them the following types of is considered as one of the major diseases. The toilets are commonly used in Nepal: average records of diarrhea in far western development region, mid-western development I. Water seal offset type single pit region, western development region, central These have a squatting hole in the cover development region and eastern development region slab; they have a shallow toilet pan with a U shaped is 239, 260, 205, 218 and 259 respectively per 1000 water seal. It is used where there is sufficient amount population of fewer than five years of age (MoHP, of water and there is less chances of odor. This type 2006). of latrine can be easily constructed and also suitable for low income group people. But there also the chances of ground water .

Fig. 1: Water seal offset type latrine (Source: DWSS, 2014)

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II. Water seal latrine (direct pit type) pit so there are maximum chances of odor and health These latrines are useful in hilly areas where hazard issues. To stop odor, people can use ash or water logged areas are less. It can be constructed with dust or dry leaves after defecation. It is used local materials. The squatting hole is just above the where is less availability of water.

Fig. 2: Water seal/ Direct (Source: DWSS, 2014)

III. Ventilated Improved Pit latrine (Sulav Files are attracted at the top of the ventilated pipe due Sauchalaya) to the presence of light but cannot escape due to It is similar to conventional pit latrine but has a screen thus helping in reduction of of offset that permits the installation of vertical . There are also the chances of ground water ventilated pipe. It allows for the air flow through the pollution. ventilated pipe which helps in reduction of odors.

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Fig. 3: Ventilated pit latrine (Source: DWSS, 2014)

IV. Latrine for differently able people This latrine is designed for differently able people. Ramp with landing is provided at the side of the door. Door should be made in such a way that it can be easily opened during emergency.

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Fig. 4: Latrine for differently able people (Source: DWSS, 2014)

V. (ECO-SAN) latrine (Dry Wet type: This type of latrine has the provision of and Wet Type) using the special type of pan which separates Dry type: It is based on the concept that human and excreta and water is used for flushing. But urine waste contains nutrients which helps in increasing the is separated and collected separately. It is also fertility of the . In this toilet urine and excreta are relatively expensive than other simple toilets and also collected and disposed off separately. It is suitable for requires the skilled manpower for the construction. all group people whether in rural or small town areas. It is little bit expensive as compared to other simple type latrines.

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Fig. 5: ECO-SAN latrine (Wet/ Dry type) (Source: DWSS, 2014)

VI. Latrine with and soak pit the health of human being, thus effluent is collected These type of latrines are used in those areas in the soak pit which helps infiltration of effluent. where there is no provision of sewerage facilities. It This type of latrine is relatively expensive and is like offset type of latrine which is attached with difficult to maintain due to the requirement of skilled septic tank and soak pit. Septic tank is the water tight manpower. Also large space is required for structure which helps in separating and digesting the construction compared to other latrines. solid . The liquid effluent is very harmful for

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Fig. 6: Latrine with septic tank and soakpit (Source: DWSS, 2014)

The above types of toilets are considered as low toilets for girls (DoE, 2011). As there are many cost and suitable to most of the localities in Nepal schools which have no separate toilets for girls, they (DWSS/ESDMS, 2011). However, constructions of are compelled to leave school during the day time toilets are not widespread in Nepal. As there is less (MDG, 2010). There are no proper physical facilities awareness and there is no rule of compulsion to build such as separate toilets for girls and boys, privacy, toilets; many people of low and mid-level economic physical facilities to dispose of sanitary items or safe status are without sanitation facility. Thus, they and clean facilities to sanitary cloths (UNICEF, openly defecate, which has myriad of adverse 2009). That’s why girls especially adolescent do not impacts. Among them diarrhea and Acute go to school. Respiratory Infection (ARI) are the major ones. Twelve percent (12%) children are experiencing 4. IMPACT AND SUSTAINABILITY OF normal diarrhea and 2% under five year are ODF experiencing fatal diarrhea. Seven hundred thousand 4.1 IMPACT OF ODF (700,000) children died due to poor sanitation and After the declaration of ODF, the people in all hygiene during last decade (CBS, 2011; MoHP, communities have started to maintain clean 2006). There are no toilets in many community environment in their surroundings. Personal hygiene managed schools. Only about 80% community has significantly increased compared to the previous managed schools have toilet facilities. And, out of stage (i. e. before declaration of ODF). Community 80%, only 65% community schools have separate www.ijera.com 126 | P a g e Khet Raj Dahal et al Int. Journal of Engineering Research and Applications www.ijera.com ISSN : 2248-9622, Vol. 4, Issue 8( Version 7), August 2014, pp.118-128 members are found to have fully internalized health country. Reliable financing mechanisms are needed and hygiene messages including to replace or upgrade basic latrines and sanitation practices at critical period. They have constructed marketing (Hanchett et al., 2011). washing platforms to maintain personal hygiene There are many temporary toilets in the rural (Sah, 2013). Furthermore, the practice of open areas of Nepal. Such toilets collapse easily in wet defecation has significantly reduced. People have the seasons. Then people go to open defecation (Plan, feeling of “we” instead of “I”. Definitely, when there 2012). But the people having permanent type of is a feeling of “we” in a community, there will toilets hardly go back to the open defecation. This always be an improvement and social change. indicates that the sustainability of ODF depends on In all places of ODF declaration areas of Nepal, the types of technology used in the toilets. women and children are the most involved group in Institutions also play the major roles for the whole process of community mobilization. In all sustaining ODF. If there is no active water and settlements there are some women groups. And this sanitation users committee, sustainability of ODF is group was found to be active for maintaining better questionable. There must be post ODF activities in sanitation in the village. Women have empowered the village and it has to get some legal status. In the and they come into the meeting and share their context of Nepal, in every village, there is an active knowledge and experience with others. They openly users’ committee and VDC has led it. And, in the take part in the meetings and related developmental later phase, VDC has supported to upgrade the toilets works in their villages (Sah, 2013). Similarly, people in most of the cases. As a result, sanitation coverage are becoming more civilized compared to the in local level is accelerated (Plan, 2012). Similarly, previous stage of ODF. They convey the message of sanitation programme can spread within the ODF for a new comer to their houses. Thus, any community very easily if it is interlinked with other guest could be informed about the ODF and programme (Plan, 2012; Sah, 2013). punishment for the violation of ODF. Water and Technical documents are lacking on sanitation related diseases such as diarrhea, skin sustainability of ODF in Nepal. Violation of ODF is infection and jaundice have been reduced after the mainly due to the lack of awareness among people. ODF campaigning in many parts of the country Existing toilets are not users’ friendly. And, they (Plan, 2012). Similarly, school drop out of girls has need maintenance (Sah, 2013). Educational level is reduced in the declared zone of ODF. Children are also related to utilization of toilets in many parts of not suffering from fatal diarrhea. The ODF campaign the country. Similarly, income level of people is has is spreading community to community, village to effects on utilization of toilets in Nepal. Thus, village and district to district in a rapid way (Sah, success of sanitation programme depends on many 2013). factors. Stage-wise sanitation programme can be successful in the country like Nepal. Institutional 4.2 SUSTAINABILITY OF ODF arrangements, post ODF campaign and behavioral Generally, sustainability of ODF situation development, research and development, knowledge depends on the awareness of the community. management, monitoring, evaluation, reporting and Neverthless, durable sanitation solutions of their follow up programme can play the vital role to choice can be helpful to sustain ODF. Failure of ODF sustain ODF situation in Nepal (SHMPIG, 2013). can be less monitoring, use of very cheap materials, There are some organizations in Nepal, which lack of information in communities about low cost, support for toilet construction. However, progressively upgradable improved sanitation options sustainability of ODF will be more challenging if in the communities, and sharers continuing with open external supports for household toilets are available defecation (Mukharjee, 2012). (Sah, 2013). Proper planning, technical assistance, Similarly, topography like water-logged area, and participatory approach play the vital role for high ground , and soil types play a vital ODF sustainability. Similarly, post ODF provisions role for the sustainability of ODF. Furthermore, less should be clearly defined, which should include the priority is given to sanitation facilities compared to continuation of awareness programmes among local other , weak institutional capacity and people. communities not recognizing the benefits from the Regular monitoring mechanism and provision of sanitation facilities are the factors, which govern the reward and punishment should be established for the sustainability of ODF (Kumar, 2012). Long term sustainability of ODF. If somebody violates ODF, sustainability of ODF depends on the political he/she should be excluded from the society and social commitment as . But there is no political stability service from the local administrative bodies should in Nepal for many years and it has made difficulty for be avoided for such persons (SHMP, 2011; Sah, ODF programme. Local government must provide 2013). Educational institutions/Schools should be continuous financial support for the sustainability of properly mobilized for awareness creation and ODF. This is also not available in all parts of the behavior modification. Financial support to ultra poor

www.ijera.com 127 | P a g e Khet Raj Dahal et al Int. Journal of Engineering Research and Applications www.ijera.com ISSN : 2248-9622, Vol. 4, Issue 8( Version 7), August 2014, pp.118-128 people should be available in conjunction with [14] MoHP, 2006. Nepal Demographic Health awareness creation. Survey Report. Kathmandu: Ministry of Health and Population (MoHP), References Government of Nepal(GoN). [1] Bartram, 2013. How Health Professionals [15] Mukherjee, N., 2012. Factors associated can Leverage Health Gains from with achieving and sustaining Open Improved Water, Sanitation and Hygiene Defecation Free communities; Learning Practices. Perspectives in from East Java. pp. 215–221. [16] Neupane, A., 2001. A Report on National [2] WHO and UNICEF progress Report on Sanitation Action Week. Kathmandu: Drinking water & Sanitation, 2012, Steering Committee for National WHO, Geneva and UNICEF, New York, Sanitation Action Week. page 2 [17] NPC, 2012. Millennium Development [3] CBS, 2011. Report on National Goal (MDG) Acceleration Framework. Population Census. Kathmandu: Central Kathmandu: National Planning Bureau of Statistics, Government of Nepal Commission. (GoN). [18] Plan , 2012. Assessment of Total [4] Devkota, B., 2011. An Operational Study Sanitation (ODF Movement) Program on ‘Open Defecation Free (ODF) through CITS approach. Kathmandu: Plan Situation’ in Nepal. Kathmandu: Water Nepal. Aid. [19] Sah, 2013. Sustainability challenges of [5] DoE, 2011. School level education open defecation free zone in Nepal. A statistics of Nepal/Consolidated report. thesis submitted to Pokhara University, Kathmandu: Department of education, Nepal. Government of Nepal (GoN). [20] SHMP, 2011. Sanitation and Hygiene [6] DWSS/ESDMS, 2011.Types of toilets. Master Plan. Government of Nepal Kathmandu: Environment Sanitation and [21] SHMPIG, 2013. Sanitation and Hygiene Disaster management section, Master Plan Implementation Guidelines. Government of Nepal. (GoN) Government of Nepal [7] DWSS/ESDMS, 2013. List of ODF [22] Water Aid, 20111. An operational study declarations, Kathmandu: National on open defecation free (ODF) situation Sanitation and Hygiene Coordination in Nepal. Water Aid in Nepal. Committee, Nepal. [23] WECS, 2005. National Water Plan 2005. [8] GoN,2000. Nepal State of Sanitation Kathmandu: Water Commission report. Kathmandu: Government of Nepal Seretariate. (GoN). [24] WHO and UNICEF, 2004. Water, [9] GoN,2004. Rural Water Supply and Sanitation and Hygiene links to Health, Sanitation Policy and Rural Water Supply Facts and Figures. Geneva: World Health and Sanitation National Strategy. Organization. Kathmandu: Ministry of Physical [25] WHO and UNICEF, 2012. Joint Planning and Works, Government of Monitoring Program for Water Supply Nepal. and Sanitation. Kathmandu: Government [10] GoN, 2011. Sanitation and Hygiene of Nepal. Master Plan. Kathmandu: National Sanitation and Hygiene Coordination Committee, Government of Nepal (GoN). [11] Hanchett, S., Krieger, L. and Kahn, M.H., 2011. Long term sustainability of Improved Sanitation in Rural . Washington D.C.: Water and Sanitation Program World Bank. [12] Kumar, R.S.A., 2012. : A new paradigm in Aceh, Indonesia. [13] MDG, 2010. Millenium development goal progress report, Kathmandu Nepal. NPC/ United Nations Country Team of Nepal.

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