A new way to fund health care for the most vulnerable | Andrew Bastawrous

46,878 views ・ 2018-10-01

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These two Kenyan ladies were best friends
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from neighboring villages,
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but they'd stopped seeing each other, literally, for 10 years,
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because both had gone blind from a curable condition called cataracts.
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They hadn't been aware they'd been sat together for over an hour
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when we offered them surgery at the nearest hospital.
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Mama Jane, on the right, told me
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her biggest fear was that she would poison her grandson,
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whom she'd never seen,
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because she couldn't see what she was cooking for him.
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Her arms were covered in burns from cooking on a charcoal stove,
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and she despaired that she was robbing her six-year-old grandson of his childhood
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because he was effectively her eyes.
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The effect of her blindness was going through the generations.
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He wasn't able to go to school or break the cycle of poverty.
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All of this, despite cost-effective solutions existing.
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Cataract surgery can be done in under 10 minutes
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for just a hundred dollars.
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Four in every five people who are blind don't need to be;
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curative or preventive treatments already exist.
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Fortunately for Mama Jane and her friend,
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a donor had provided treatment
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so that we could take them to the nearest hospital
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three hours away.
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But in that very same clinic,
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I met Theresa,
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a shy young woman who couldn't look me in the eyes,
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not because she couldn't see,
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but the appearance of the growth on her eyes called pterygium
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meant she'd lost her confidence,
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and with it, her place in her community.
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She had no prospects for marriage or children
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and had been completely ostracized.
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I knew how to treat her condition; it was pretty straightforward.
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But we had strict instructions that the funds we had
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were for people with cataracts.
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What was I supposed to do?
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Ignore her?
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My wife and I managed to raise the funds to cover her treatment,
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but situations like Theresa were common every day,
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where people had the wrong diseases.
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And by the "wrong diseases,"
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I mean conditions for which funding hadn't been earmarked.
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Earmarking may seem like smart business or smart philanthropy on paper,
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but it doesn't make any sense when you're looking the person in the eye.
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Yet, this is how we deliver health care to millions of people the world over.
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I've been thinking about this problem for a very long time.
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Things happened to me at the age of 12 that completely transformed my life.
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My teachers insisted that I would go for an eye test.
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I resisted it for as many years as I could
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because as the only brown boy in the school,
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I already felt like a chocolate chip in rice pudding,
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and the idea of looking more different was not particularly appealing.
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You see, I'd associated an eye test with wearing glasses
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and looking different,
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not with seeing differently.
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When eventually I was persuaded to go,
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the optometrist fitted me with the trial lenses
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and was shocked at just how poor my sight was.
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He sent me outside to report what I could see.
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I remember looking up and seeing trees had leaves on them.
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I had never known this.
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Later that week, for the first time, I saw stars in the night sky.
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It was breathtaking.
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In fact, the entire trajectory of my life changed.
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I went from a failing child at school who was constantly told I was lazy
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and not paying attention
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to suddenly being a child with opportunity and potential.
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But I soon realized that this opportunity was not universal.
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That same summer, in Egypt,
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the home where my parents are originally from,
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I was with children that looked a lot more like me
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but couldn't have been more different.
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What separated us was opportunity.
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How is it that I had this life and they had theirs?
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It still makes no sense to me.
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How is it we've --
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in a world where glasses, that completely changed my life
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have been around for 700 years,
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yet two and a half billion people still can't access them.
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This deep sense of injustice drove me to become a doctor,
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eventually an eye surgeon,
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and in 2012, my wife and I packed our bags and moved to Kenya
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to try and give something back.
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We started by setting up a hundred eye clinics
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across the Great Rift Valley,
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where we met people like Mama Jane and Theresa.
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We founded a new organization called Peek Vision,
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a social enterprise where we built smartphone technology
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that makes it possible for people in the community
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to find people in their homes,
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the most vulnerable groups who are being missed,
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and created new tools that made it easier to diagnose them
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and connect them to services.
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Inspired by the challenges I'd had as a child,
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we equipped teachers, 25 of them, with smartphones
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to screen children in schools.
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Our first program resulted in 21,000 children
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being screened in just nine days.
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That same program was replicated to reach 200,000 children,
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covering the entire district.
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Soon we were able to repeat this in six new programs
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in different countries.
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But now, I was faced with the very same problems I had with Theresa
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of earmarked funds,
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but now as an organization.
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People wanted to fund specific projects
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or particular diseases
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or subsets of the population.
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But it didn't make sense,
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because what we needed to do was build an incredible team
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who could create the systems that would change the lives
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of millions of people, whatever their needs were.
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But it didn't work that way.
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Soon, we were able to align ourselves with partners who understood,
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because I understand the challenge.
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Ultimately, you need to trust where your money's going,
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and that trust usually manifests through the requirement
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to create detailed plans -- lots of paperwork.
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But what happens if the dynamic needs of people
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don't fit with the plan that you created,
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and your funding is dependent on delivering the plan?
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You end up with a choice:
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Do you serve the plan, the funder,
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or do you serve the need?
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This is not a choice we should have to make,
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because ultimately, we can only serve one master.
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The measure of our humanity
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is how we serve the most vulnerable amongst us.
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Currently, the system is not working, and too many people are being left behind.
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We've been fortunate to find incredible supporters and partners,
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which led to a new program in Botswana,
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in which every single schoolchild is being screened and treated
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by the end of 2021,
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meaning an entire generation of children
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will have the opportunity that good vision affords.
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But this took years of work.
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It took multiple feasibility studies,
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engaging different partners and stakeholders,
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business cases, economic analyses,
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to persuade the government to eventually come on board.
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But they're now leading and funding this in their own national budget.
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But we did not have the resources to do this.
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Our visionary funders and partners came alongside us,
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and the key ingredients were we were aligned on mission,
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on the why we were doing it.
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We agreed on the outcome, what had to be done.
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But critically, they were flexible and gave us autonomy
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to work out how we got there,
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giving us the space to be creative, ambitious and take risk.
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What if all health care looked like this?
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What would it mean for all the social causes we're trying to solve?
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Business knows this.
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By taking a long-term, ambitious view
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and giving people the autonomy to be creative
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to solve our world's biggest challenges,
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we've disrupted entire industries.
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Look at Amazon, Google.
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Surely, we need the same level of ambition
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if we're going to serve the most vulnerable in our societies.
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As a planet, we've set a target,
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the Sustainable Development Goals,
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yet we're spending less than half the amount on tackling the global goals
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than we are on conflict resolution,
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which mostly arises from the very inequalities we're not serving.
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It's time for change.
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It's not just common sense as well -- it makes business sense.
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Our work in Botswana showed
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for a modest investment, the economy would gain 1.3 billion dollars
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over the lifetime of the children.
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That was 150 times return on investment.
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But part of the problem is that value is generated in the future,
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but we need the money now to deliver it.
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Turns out, this is not a new problem.
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Banks have been solving it for centuries.
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Simply put, it's called financing.
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If you want to buy a house
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but you can't afford to pay for it up front,
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the bank financiers, you see, can realize that future value now.
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In other words, you can live in the house straightaway.
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But what if you couldn't?
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What if you had to wait until you'd raised all of the money to move into the house,
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and you were kept homeless whilst trying to save the money
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to get there in the first place?
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You'd end up in an impossible cycle, never able to get there,
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yet that's this very same bind we've put on ourselves.
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Inspired by the change in Botswana
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and by the visionary support of our funders and partners,
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we've come together -- two world-leading banks,
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for-profit and private, not-for-profit organizations,
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foundations and philanthropists --
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to launch the Vision Catalyst Fund,
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a fund which will have trust built in by design.
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It will make funding available now
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to the organizations that can serve the need of the most vulnerable.
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It will ensure that those organizations can work together in partnership,
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rather than competing for limited funds,
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serving the priority needs of an entire population,
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whatever they are,
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so that ultimately the individuals affected
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can receive the care that they deserve.
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And as we've shown,
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it doesn't make just a health and social difference,
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it creates huge economic benefit.
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This benefit in itself will create sustainability
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to perpetuate a virtuous, catalytic cycle of improvement and change.
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Because when we do this,
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the individual needs of people like myself can be met.
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And this coalition has come together this year
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to make a commitment with 53 heads of government,
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who have now committed to take action
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towards achieving access to quality eye care for all.
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We've had incredible commitments
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of 200 million pairs of glasses to the fund
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and millions of dollars,
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so that the dynamic and individual needs of people --
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like my own issues that I had as child,
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and like Theresa, who just required simple surgery --
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can be met.
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For Theresa, it meant her place back in society,
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now with her own family and children.
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And for Mama Jane, it wasn't just restoring her sight,
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it meant the opportunity to restore hope,
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to restore joy
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and to restore dignity.
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(Music)
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Thank you.
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(Applause)
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