Key Takeaways from the AMMTEC Conference: Advancing Pharmaceutical Manufacturing in Africa

The Health Finance Coalition recently had the privilege of participating in the African Medicines Manufacturing Trade Exhibition and Conference (AMMTEC) held 20 – 22 November in Dar es Salaam. The conference brought together stakeholders from across the pharmaceutical manufacturing ecosystem, including manufacturers, global funders, government representatives, and other key players, offering a unique platform to exchange insights, address challenges, and explore opportunities shaping the future of pharmaceutical production on the continent.


Key takeaways include:

  1. Collaboration as a Catalyst for Progress
    From the outset, the conference was rich with engaging discussions and inspiring moments, reinforcing the critical role collaboration plays in progressing Africa’s pharmaceutical manufacturing sector. Attendees underscored the need for unified efforts among industry players, policymakers, and funders to overcome systemic barriers, such as financing gaps, regulatory hurdles and market competition, as well as unlock the sector’s full potential.
  2. Flexible Financing Models for Growth
    Pharmaceutical manufacturers on the continent face diverse needs, and rigid financing structures often hinder growth. The conversations at AMMTEC emphasized the value of flexible financing models tailored to the realities of these businesses. Whether through blended finance, patient capital, or innovative debt structures, attendees stressed that creating adaptable financial solutions is vital to supporting manufacturers’ expansion, innovation, and resilience.
  3. Balancing Quality and Streamlined Regulation
    While maintaining high-quality standards is non-negotiable for pharmaceutical manufacturers, the conference highlighted how burdensome regulatory processes can stifle growth. Stakeholders called for a more streamlined regulatory framework that supports compliance without imposing unnecessary hurdles, a balance that is crucial for enabling manufacturers to scale production while maintaining the quality required for global competitiveness.
  4. Financial Sustainability Beyond WHO Prequalification
    Although achieving WHO prequalification (PQ) is a critical milestone for many manufacturers, financial sustainability cannot end there. Discussions underscored the importance of robust financial planning and modelling to ensure long-term viability. Attendees also stressed how manufacturers must go beyond compliance and focus on creating sustainable profit margins to compete effectively with international suppliers. It was also emphasized that financial planning and a deep understanding of target markets and the interplay between costs, pricing and profitability are crucial.

The AMMTEC conference reaffirmed the urgency of addressing these interconnected challenges and opportunities. By embracing collaboration, innovative financing, streamlined regulation, and financial sustainability, the sector can rise to meet its full potential.


At the Health Finance Coalition (HFC), we are inspired by the insights and partnerships forged during the conference. We remain dedicated to providing solutions that not only enhance access to medicines but also strengthen the financial health and strategic direction of the sector.


To learn more about the work of the Health Finance Coalition, visit healthfinancecoalition.org.

Investing In Our Future: A Conversation with Cees Rustenhoven, Healthy Entrepreneurs’ Chief Financial Officer

In an interview with the Health Finance Coalition, Cees Rustenhoven, Chief Financial Officer with Healthy Entrepreneurs, discusses the critical role of innovative financing for scaling healthcare solutions.

How and why did Healthy Entrepreneurs start?

RUSTENHOVEN: The founder of Healthy Entrepreneurs, Joost Van Engen, first worked for a wholesale company that distributes medicines and health products in Africa and other developing countries throughout the world. In that time, he realized that if Coca-Cola can get its products just about anywhere Africa, why couldn’t you deliver medications or healthcare products more effectively. So, Engen started thinking about a kind of network or franchise, or even small kiosks, that could sell medicines and various products in more rural or desolate areas of Africa.

He pitched the idea as a business case for the company he was with, but they weren’t interested. So, he thought …what if I quit and start my own company? It was a bold idea but that’s how it started over a decade ago. First, we did a few assignments for a small NGO in the Netherlands. Then we got grants from the Ministry of Foreign Affairs to serve a company in Africa.

And it was in that early start that I joined Healthy Entrepreneurs, because they were wanting to bring onboard someone who could manage the financials. So, we continued that journey, scaling up the company, particularly these last couple of years. Now, we are active in seven different countries.

As a business model, what has been Healthy Entrepreneurs’ evolution? What have you learned through the process?

RUSTENHOVEN: We have improved quite a lot. But the changes we’ve made weren’t something that just happened in a day. But over the years, we have evolved and now do things completely differently from when we first started. For one, we came to appreciate that it’s really community health workers who are the heart of any community and are trained and already registered by local governments. They’ve become the basis for our business. We recruit, train and make them community health entrepreneurs. We do that in close collaboration with local health authorities. We essentially sell our products to community health entrepreneurs, and they, in turn, sell the products to the end customer.

For us, it’s not about sales, as much as it’s about engagement, because we know that these entrepreneurs need to be engaged with the community for this to work. It’s not just about asking someone if they are ready to place an order. It’s more. You need to sit next to them, listen to them, coach them, and support them in doing their own business. If we do that, then the sales increase automatically. So that model now determines the people we are recruiting for this type of engagement.

Healthy Entrepreneurs has also used an outcome-style convertible note model? Can you explain more?

RUSTENHOVEN: That’s been an important step in the process. In 2020, we had our first financing round, and our initial investors were willing to invest more than half a million dollars into Healthy Entrepreneurs. Then, we negotiated the interest percentage and how much it would increase year over year. But it’s a loan that’s not part of your equity. Therefore, we also agreed to a certain profit sharing. So, at the end, if we are reaching a certain EBITDA level, meaning “earnings before interest, taxes, depreciation, amortization”, they would get a certain, part of the profit.

On the other hand, if we reached specific impact targets, then that resulted in a lower profit sharing.

So, that model served as a stimulus for us to reach social impact because there’s also a financial benefit for the company.

At the same time, we only want to have investors on board who are interested in the social impact and not only there for financial benefit.

Not many companies are making these types of agreements but it’s truly a win-win model. The loan, profit sharing and the social impact all come in together to achieve more healthcare solutions.

What would you say about the role of innovative or blended financing structures on scaling healthcare solutions?

RUSTENHOVEN: If you look at our business case, we are dealing with community health entrepreneurs who are living in desolate and rural areas of Africa. People there often earn just $1 or $2 a day. So, most orders being made by our community health entrepreneurs are often relatively low.

So, our business case is not the strongest commercial business case. We’re focused on the social business case. But still, there is a business case. Between the combination of public funding and commercial funding, it becomes a more sustainable business case than all the NGOs actively dealing with community health workers.

A couple of months ago, I was in Uganda, and I spoke to someone from an NGO that focuses on community healthcare. And they said, our Healthy Entrepreneurs model has essentially never-ending projects since our model is based on community health workers or entrepreneurs who remain in communities and can making a living from their business. Of course, not all our entrepreneurs reach that level of success, because some are higher performers than others. But still, there are quite a number of entrepreneurs who can make a living from their business and have a sustainable business model opening doors in the most rural areas of sub-Saharan Africa.

So, for us, that combination really makes this model extremely powerful, and opens up opportunities to scale healthcare using this network of community health entrepreneurs.

We can also finance innovations and new approaches, which is something we’ve done for communicable diseases, NCDs. We set up a closed supply chain to pick up orders from chronic patients through our call centers. We now have doctors on the payroll who can write prescriptions, and we can distribute medicines with a simple barcode scanned by a smartphone. We make sure each community health entrepreneur has a smartphone, where he or she can place online orders, and ensures the correct order is distributed to the appropriate patient.

That happens through public funding. But when we scale up, we need working capital. We then add in some commercial funding into our company so that we can continue to scale our business model.

What other innovative healthcare solutions are in the pipeline?

RUSTENHOVEN: We know the smartphone is increasingly being used also to register housing data of people living in the most desolate places. For example, the Electronic Community Health Information System (eCHIS) is digitizing community health information registered on household level. It’s expected that these information systems will play a critical role in measuring the performance of healthcare delivery and generating the necessary data for program monitoring, planning and evaluation. And it’s that kind of system that community health workers will then use to register every single household in each desolated village in Africa.

We are also seeing an increase in health apps with counselling services, videos and different tools for measuring vitals. Ultimately, what we would like to see, is a central database for all this information. Because, when we know the demands or the health needs of customers, then we can, in turn, provide the necessary products and services.

For those who haven’t considered innovative financing structures, what would you say?

RUSTENHOVEN: We thought that we were only making the margin, on the sale of products. But through the sale of our products, we are also making an impact.

Now, when an NGO comes to us and wants to try out a health intervention, we already have a network for scaling up. So, this network has a certain value. It’s not just about selling products and earning margin. It’s more about this network of community health entrepreneurs which can be used for health interventions.

For example, we distributed a product that is an injectable contraception. In Africa, if a woman gives birth four or five times, many times the sixth can be fatal. In order to prevent that, they get this injection and are protected for several months. So, we have partnered with an NGO that now pays us to distribute this injection and train our community health entrepreneurs to give this kind of an injection to women. That’s a good example of how we can use this network to scale a healthcare solution and achieve more social impact.

It is still quite cheap to distribute, but now we’re seeing more governments getting involved and wanting to use this type of network.

But this all stems from a combination of public and private funding – combining commercial funding for the working capital and public funding for startup and innovations. This way, you get a combination, which makes it more powerful and sustainable. The result is a larger network that is maintained and supported by community health entrepreneurs in the most remote areas of Africa.

After more than a decade of doing this work, I think we’ve developed a very stable business model with community entrepreneurs who will be with us for decades to come.

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ASTMH 2024: A Discussion on Financing Private Sector Innovations in the Era of Antimalarial Resistance

Last week in New Orleans, the Health Finance Coalition was invited by Maisha Meds, a digital health organization, and Jhpiego, a global health non-profit organization, for a side event on the sidelines of the American Society of Tropical Medicine and Hygiene (ASTMH) annual meeting.


In a discussion facilitated by the Gates Foundation’s Abigail Pratt, panelists – including HFC’s Alex Honjiyo – explored how innovative financing methods can effectively engage the private sector to catalyze the scale of innovations to fight antimalarial resistance.


Malaria financing has become increasingly challenging
Panelists discussed how over the past five years external financing for malaria has plateaued and, in some cases, decreased. This stagnation in donor support and ongoing gaps in malaria funding highlight the urgent need to develop new and innovative mechanisms of financing implemented at the global, regional, and country levels.


“Financing solutions are very important because they are a way for sustainable financing to provide quality malaria services to the most vulnerable,” said Dr. Samwel Lazaro, Head of Tanzania’s National Malaria Control Programme.


This was echoed by Dr. Maria Dieci, Emory Rollins School of Public Health, who highlighted that “the current ways, where funding is coming from, are going to continue to be constrained and will continue to pose challenges going forward.”


Leveraging the private sector offers a path to more sustainable financing
Panelists also discussed how countries and development partners are increasingly looking at market-based approaches and investments from the private sector to help bridge gaps in both malaria resources and expertise to sustain results and accelerate progress.


National, public sector malaria programs recognize this need. During the panel discussion, Dr. Lazaro underscored this challenge, stating that “we need to bring the private sector onboard, so they become part of the solution making. Under the current financing mechanisms, we are not able to engage the private sector appropriately,” said Dr. Lazaro. “We need to rethink how we get the funding solutions that would be sustainable to the private sector but are also complementary to working with governments. We have to make our policies friendly to the private sector.”


“We will need to be more creative in how we think funding and financing for the malaria fight as we continue to seek elimination” said Alex Honjiyo, Deputy Director of the Health Finance Coalition. “At the Health Finance Coalition, when we think about engaging the private sector, we are constantly looking to engage a wider range of investors and implementors to achieve the world’s global health goals,” said Honjiyo. “Often as we look to de-risk investment, we are thinking about what kinds of financing and funding mixes could make the global health sector or malaria interventions more attractive for private sector investors. At HFC we call this a capital stack approach. Similarly, public-private partnerships can extend the impact of public sector anti-malaria programs while creating space for return-seeking investment.”


Outcome-based financing models offer solutions for financing malaria programs
Outcome-based financing models, or performance-based, can be used to improve malaria programs by aligning financial incentives with public health goals, panelists agreed. “It’s basically procurement reform at a very basic level,” said Honjiyo, “governments engaging in a public-private partnership, contracting a service from a non-profit or company.”


While often complex, panelists agreed that outcome-based financing models are an effective tool for yielding both effective health outcomes as well as potentially new funders for the malaria fight. “These outcomes funding methods open the door for impact investors to get involved, expanding the pie for potential investors in this space” Honjiyo said.


A benefit of outcomes funding models is that they are inherently driven by the achievement of impact metrics. “Financing should be driven by the outcomes that we want to do,” said Dr. Maria Dieci, Emory Rollins School of Public Health. “Ultimately, we need to be nimble to adapt to changes and outcomes funding can be the guide… An important pillar of any financing proposition that we think about has to include targeted interventions that are driven by an incentive to change the behavior of last mile providers patient and or improving diagnostics. Outcomes funding models are a great way to achieve this.”

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Investing In Our Future: A Conversation with Noorin Mawani, Co-lead of the Transform Health Fund

In an interview with the Health Finance Coalition, Noorin Mawani, co-lead of the pan-African recently- closed Transform Health Fund (THF), discusses the fund’s innovative blended-finance structure, which aims to bolster healthcare systems in Africa by scaling proven and innovative healthcare models. Earlier this month, AfricInvest and The Health Finance Coalition (HFC) announced the Transform Health Fund exceeded its initial target in its final close, raising $111 million, through commercial, public, and private donor investments.

What makes the Transform Health Fund unique?

MAWANI: What makes the THF unique is its investment strategy that focuses on reaching low to middle income patient populations in Africa which today lack accessible and affordable healthcare

Too often, healthcare investments target companies serving middle- to high-income patients. That’s been for a few reasons: First, investors with high target returns tend to focus on patient populations with a dependable ability to pay. Unfortunately, in many African countries, less than 10% of the population has private health insurance. And while public healthcare systems dominate, many people rely on out-of-pocket payments for medical expenses, and yet to not have the means to cover them. The second reason healthcare investors target companies with higher income patients is geographical. These companies are typically located in large cities and so they are better known.

THF’s focus on low-income patient populations is made possible by a blended capital structure at the Fund level, that allows us to focus on companies expecting moderate returns.

Can you describe how blended financing is used?

MAWANI: With blended financing, different types of capital (with different return requirements) are combined into one fund structure. In more traditional funds, there is just one type of share class for all investors who all receive the same terms.  

By combining investors with different risk and return expectations, it is possible to “grow the pie,” or catalyze investors who may not have otherwise had the risk appetite to invest, and providing the opportunity for Africa to see a greater share of international capital flows.   

Where does the Transform Health Fund fit into the health financing ecosystem?

MAWANI: The health financing ecosystem is extremely wide, spanning donors who give philanthropic grants to larger institutional players like UNICEF, the US government, PMI Healthcare and many others.

I think about the providers of finance on a continuum of returns. On one extreme, there are those who do not expect even the return of their principal, providing grants and donations. Many are motivated by the belief that the provision of adequate healthcare is a basic human right, and grant financing is sometimes required to help ensure this

In the middle, there are those interested in supporting health in emerging markets given their development impact agenda, who still require a rate of return, but perhaps not a fully market adjusted rate of return. Think of a development finance institution – e.g., BII or IFC. They use limited taxpayer money to drive development in the least developed nations across the world but require a return to sustain their ability to invest.

Moving across the spectrum, the financing available becomes increasingly commercial in nature. Market returns are expected and while impact is an important outcome, it is not necessarily the primary intention of the investment.  

This continuum is a necessary feature of the healthcare finance ecosystem. There are some parts of the market, some subsectors, some geographies, where pure commercial investments are unavailable, and philanthropic capital has a critical role to play.

In my view, there is a place for all types of capital – across geographies and across different subsectors. However, it is critical that the right capital is being used for the right kinds of projects. Commercial money should not be used for something that should have been funded by grants, potentially leaving commercial investors disappointed. At the same time, using grant or donor money for a commercial investment is not an efficient use of precious grant dollars.

That’s the challenge for us all making sure we’re matching our capital and the requirements of our capital to the type of risk and expected return of the projects.

What does it mean to be impact focused? And where do you see the most healthcare impact?

MAWANI: For me, being impact focused is basically identifying the kind of impact you’re trying to achieve, and then aligning your internal processes, your fund governance, and your incentives to achieve that objective.

For example, we consider ourselves impactful, because we’ve stated what our impact policy is, and we have a way to govern that. We have an investment committee process that considers impact votes on whether a project is sufficiently impactful.

We also have incentives tied to impact. For our investors and for ourselves, it is not enough to just deliver financial returns and so it is only fair that our incentives are ties to impact.

What challenges exist for scaling healthcare innovations in Africa and deploying capital?

MAWANI: One of the challenges we face, like other sectors in Africa, is the ability to pay. To increase access to healthcare services, either the services must become more affordable or the patient’s ability to pay must improve.

The challenge in Africa is that both of those are difficult. It’s hard to bring down the cost of healthcare, especially since he primary input into the cost of healthcare is labor. There are just not enough trained medical staff on the continent. And even those trained in the medical profession on the continent are tempted to leave for other markets where there’s more financial opportunity.

The other big challenge is the cost of drugs and pharma. Africa doesn’t manufacture adequate supplies of pharmaceutical products for its population and while there are efforts to encourage local production, many barriers still exist: The cost of energy is high, financing isn’t always available, and prices of products from other emerging markets are extremely competitive.

On the other hand, helping to improve a patient’s ability to pay is typically driven by two things: First, increasing income, a variable that it not in the control of healthcare investors. Secondly, increasing the availability of health insurance. While improvements in this regard are underway in some markets, it is a long road, and often requires government intervention and regulatory support.

 Despite these important challenges, they are part of what makes African healthcare investing so exciting and such a big opportunity.

That’s where the innovation comes from, particularly companies targeting decreases in the customer cost of care.

With this final close, would it be fair to say you’re optimistic?

MAWANI: Definitely. I think we’re very optimistic because of achieving this final close of THF for an amount surpassing our target. As you can see, the is a great deal of interest and drive from investors to finance companies providing innovative solutions to some of Africa’s most pressing healthcare challenges.

And from the investments we’ve made so far, we’ve found incredible opportunities to solve for affordability. Still, this is by no means an easy sector. But we’ve found really strong entrepreneurs who are finding ways to drive innovation.

Finally, we are inspired by our investors, because at the end of the day, we’re a conduit for their money. It’s still their money and they’re still taking the risk.

So, our optimism is driven by both investors, as well as the hard work being done by the entrepreneurs themselves. While we are pleased with the success of the Transform Health Fund, investors and entrepreneurs are really the ones that are going to solve Africa’s healthcare problem.

Financing is just one piece of the puzzle that we try to unlock for them.

Q: Can you talk about Health Finance Coalition’s Transaction construction role in the fund? How does HFC’s support enhance THF’s investment process? 

MAWANI: The Health Finance Coalition (HFC) plays a crucial role in structuring transactions that drive the development and execution of investment opportunities, strengthening THF’s pipeline, value proposition to companies, impact, and overall fund performance. HFC provides healthcare companies with strategic, financial, impact, and transaction structuring support, offering customized solutions that enhance their readiness to attract investment from partners like THF.

A recent example of this work is HFC’s collaboration with THF’s investee – Lapaire, an optical retailer operating across Africa. HFC assisted Lapaire in assessing strategic, high-impact opportunities designed to generate sustainable financial and social outcomes. By aligning management on the optimal strategic growth path, HFC helped Lapaire maximize impact while safeguarding THF’s investment value.

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Transform Health Fund Surpasses $100 Million Target Final Close to Improve Access to Quality Healthcare in Africa

NAIROBI, October 3, 2024 – AfricInvest and The Health Finance Coalition (HFC) today announced the final close of the pan-African Transform Health Fund (THF), an innovative blended-finance fund that aims to bolster healthcare systems in Africa by scaling proven and innovative healthcare models across the continent.

Under the management of AfricInvest, a leading pan-African investment platform active across private equity, venture capital and private debt, in collaboration with the Health Finance Coalition, a group of leading global health funders, the Transform Health Fund exceeded its initial target, raising $111 million, through commercial, public, and private donor investments.

Notable fund investors include Royal Philips, the International Finance Corporation (IFC), Swedfund, the U.S. International Development Finance Corporation (DFC), Proparco, Merck & Co., Inc., known as MSD outside of the United States and Canada, FSD Africa Investments, Grand Challenges Canada (with funding from Global Affairs Canada), ImpactAssets Inc., the Global Health Investment Corporation (GHIC), Ceniarth (the family office of Diane Isenberg), UBS Optimus Foundation, Skoll Foundation, Chemonics International, Anesvad Foundation, Netri Foundation, U.S. Agency for International Development (USAID).

The successful closing allows THF to expand its investment into locally led health supply chains, care delivery, and digital solutions in Africa, providing debt and mezzanine financing to scale proven high-impact health enterprises serving vulnerable communities while offering risk-adjusted returns to investors. 

The Transform Health Fund has already committed $20m in financing to: 

  • Africa Healthcare Network (AHN), the largest dialysis chain across Sub-Saharan Africa, delivering high-quality, life-saving dialysis and preventative care treatment at affordable cost.
  • Lapaire Glasses, a network of more than 60 optical shops, providing affordable and accessible eye care products and services across six countries in West and East Africa.
  • Insta Products, a producer of ready-to-use therapeutic food for millions of malnourished children and mothers across sub-Saharan Africa, supplying its accredited products through international NGOs.

The Transform Health Fund, publicly highlighted in December 2022 at the U.S.-Africa Leaders’ Summit in Washington, D.C., was established to address Africa’s massive health financing and capacity gaps. While Sub-Saharan Africa is home to 14 percent of the global population and 20 percent of the global disease burden, just 1.6 percent of annual impact investments target the healthcare sector in Africa.

“Financing companies in Africa’s health sector through innovative financing models such as the Transform Health Fund is critical to address Africa’s health financing and capacity gaps,” said Ziad Oueslati, Founding Partner, AfricInvest. “By teaming up with private sector leaders, the Transform Health Fund has become a proven model for scaling locally led healthcare solutions across the continent.”

“The Transform Health Fund demonstrates that health enterprises serving the most vulnerable communities are in fact investible,” said Martin Edlund, CEO, Malaria No More and Executive Director of the Health Finance Coalition. “The context of static donor funding for health and unsustainable debt for African countries makes private investment in high-impact healthcare more important than ever.” 

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For more information on the THF, please contact Noorin Mawani at noorin.mawani@africinvest.com. For interview requests, please contact Mindy Mizell at mindy.mizell@malarianomore.org.

About AfricInvest:

AfricInvest is a leading pan-African investment platform active in multiple alternative asset classes including private equity, venture capital, private credit, and listed equities. Over the past quarter century, the firm has raised more than $2bn to finance more than 200 companies at various development stages, delivering value and impact for its investors, portfolio companies, and the communities they serve. The 100-person-strong team of investment experts in more than ten offices across three continents has a proven track record of providing attractive risk-adjusted returns while spurring productivity growth, creating jobs, and ultimately improving African lives through inclusive and sustainable development. Learn more at: www.africinvest.com

About the Health Finance Coalition:

The Health Finance Coalition (HFC) was launched by a group of leading philanthropies, investors, donors, technical partners convened by WHO Ambassador for Global Strategy and Health Financing Ray Chambers and hosted by Malaria No More. The HFC seeks to attract an unprecedented level of private-sector investment to impact millions of lives and accelerate progress to ensure healthy lives and promote well-being for all, a UN Sustainable Development Goal 3. The coalition uses public and philanthropic funding to encourage private-sector capital investment in transformative healthcare impact. Learn more at: healthfinancecoalition.org

Ready for Investment, Ready for Scale: HFC’s approach to supporting African manufacturers

To scale manufacturing locally, African manufacturers must receive support to better understand the realities of the markets in which they operate, strengthen business planning, and understand the connection between market structures, competition, and regulatory requirements with their revenues. Without such “investment-readiness” support, manufacturers will be unprepared and unsuccessful in accessing catalytic growth financing from DFIs and other impact investors.

Associate, Health Finance Coalition

The rapidly expanding Health Finance Coalition is seeking to hire an Associate to join our team. The Associate will support transaction construction, global financing platforms, and strategic exploration of new opportunities.

How Investors Evaluate Healthcare Opportunities

Emerging markets, or economies transitioning into developed economies, shoulder a disproportionate share of the global disease burden, but their health systems are often underfunded and overwhelmed. For example, according to the World Health Organization (WHO), African countries, are exposed to 25% of the global disease burden yet receive less than 1% of the global health expenditure.

Interested in learning more?

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