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

Translator: Reviewer: Daban Q. Jaff

These two Kenyan ladies were best friends

from neighboring villages,

but they'd stopped seeing each other, literally, for 10 years,

because both had gone blind from a curable condition called cataracts.

They hadn't been aware they'd been sat together for over an hour

when we offered them surgery at the nearest hospital.

Mama Jane, on the right, told me

her biggest fear was that she would poison her grandson,

whom she'd never seen,

because she couldn't see what she was cooking for him.

Her arms were covered in burns from cooking on a charcoal stove,

and she despaired that she was robbing her six-year-old grandson of his childhood

because he was effectively her eyes.

The effect of her blindness was going through the generations.

He wasn't able to go to school or break the cycle of poverty.

All of this, despite cost-effective solutions existing.

Cataract surgery can be done in under 10 minutes

for just a hundred dollars.

Four in every five people who are blind don't need to be;

curative or preventive treatments already exist.

Fortunately for Mama Jane and her friend,

a donor had provided treatment

so that we could take them to the nearest hospital

three hours away.

But in that very same clinic,

I met Theresa,

a shy young woman who couldn't look me in the eyes,

not because she couldn't see,

but the appearance of the growth on her eyes called pterygium

meant she'd lost her confidence,

and with it, her place in her community.

She had no prospects for marriage or children

and had been completely ostracized.

I knew how to treat her condition; it was pretty straightforward.

But we had strict instructions that the funds we had

were for people with cataracts.

What was I supposed to do?

Ignore her?

My wife and I managed to raise the funds to cover her treatment,

but situations like Theresa were common every day,

where people had the wrong diseases.

And by the "wrong diseases,"

I mean conditions for which funding hadn't been earmarked.

Earmarking may seem like smart business or smart philanthropy on paper,

but it doesn't make any sense when you're looking the person in the eye.

Yet, this is how we deliver health care to millions of people the world over.

I've been thinking about this problem for a very long time.

Things happened to me at the age of 12 that completely transformed my life.

My teachers insisted that I would go for an eye test.

I resisted it for as many years as I could

because as the only brown boy in the school,

I already felt like a chocolate chip in rice pudding,

and the idea of looking more different was not particularly appealing.

You see, I'd associated an eye test with wearing glasses

and looking different,

not with seeing differently.

When eventually I was persuaded to go,

the optometrist fitted me with the trial lenses

and was shocked at just how poor my sight was.

He sent me outside to report what I could see.

I remember looking up and seeing trees had leaves on them.

I had never known this.

Later that week, for the first time, I saw stars in the night sky.

It was breathtaking.

In fact, the entire trajectory of my life changed.

I went from a failing child at school who was constantly told I was lazy

and not paying attention

to suddenly being a child with opportunity and potential.

But I soon realized that this opportunity was not universal.

That same summer, in Egypt,

the home where my parents are originally from,

I was with children that looked a lot more like me

but couldn't have been more different.

What separated us was opportunity.

How is it that I had this life and they had theirs?

It still makes no sense to me.

How is it we've --

in a world where glasses, that completely changed my life

have been around for 700 years,

yet two and a half billion people still can't access them.

This deep sense of injustice drove me to become a doctor,

eventually an eye surgeon,

and in 2012, my wife and I packed our bags and moved to Kenya

to try and give something back.

We started by setting up a hundred eye clinics

across the Great Rift Valley,

where we met people like Mama Jane and Theresa.

We founded a new organization called Peek Vision,

a social enterprise where we built smartphone technology

that makes it possible for people in the community

to find people in their homes,

the most vulnerable groups who are being missed,

and created new tools that made it easier to diagnose them

and connect them to services.

Inspired by the challenges I'd had as a child,

we equipped teachers, 25 of them, with smartphones

to screen children in schools.

Our first program resulted in 21,000 children

being screened in just nine days.

That same program was replicated to reach 200,000 children,

covering the entire district.

Soon we were able to repeat this in six new programs

in different countries.

But now, I was faced with the very same problems I had with Theresa

of earmarked funds,

but now as an organization.

People wanted to fund specific projects

or particular diseases

or subsets of the population.

But it didn't make sense,

because what we needed to do was build an incredible team

who could create the systems that would change the lives

of millions of people, whatever their needs were.

But it didn't work that way.

Soon, we were able to align ourselves with partners who understood,

because I understand the challenge.

Ultimately, you need to trust where your money's going,

and that trust usually manifests through the requirement

to create detailed plans -- lots of paperwork.

But what happens if the dynamic needs of people

don't fit with the plan that you created,

and your funding is dependent on delivering the plan?

You end up with a choice:

Do you serve the plan, the funder,

or do you serve the need?

This is not a choice we should have to make,

because ultimately, we can only serve one master.

The measure of our humanity

is how we serve the most vulnerable amongst us.

Currently, the system is not working, and too many people are being left behind.

We've been fortunate to find incredible supporters and partners,

which led to a new program in Botswana,

in which every single schoolchild is being screened and treated

by the end of 2021,

meaning an entire generation of children

will have the opportunity that good vision affords.

But this took years of work.

It took multiple feasibility studies,

engaging different partners and stakeholders,

business cases, economic analyses,

to persuade the government to eventually come on board.

But they're now leading and funding this in their own national budget.

But we did not have the resources to do this.

Our visionary funders and partners came alongside us,

and the key ingredients were we were aligned on mission,

on the why we were doing it.

We agreed on the outcome, what had to be done.

But critically, they were flexible and gave us autonomy

to work out how we got there,

giving us the space to be creative, ambitious and take risk.

What if all health care looked like this?

What would it mean for all the social causes we're trying to solve?

Business knows this.

By taking a long-term, ambitious view

and giving people the autonomy to be creative

to solve our world's biggest challenges,

we've disrupted entire industries.

Look at Amazon, Google.

Surely, we need the same level of ambition

if we're going to serve the most vulnerable in our societies.

As a planet, we've set a target,

the Sustainable Development Goals,

yet we're spending less than half the amount on tackling the global goals

than we are on conflict resolution,

which mostly arises from the very inequalities we're not serving.

It's time for change.

It's not just common sense as well -- it makes business sense.

Our work in Botswana showed

for a modest investment, the economy would gain 1.3 billion dollars

over the lifetime of the children.

That was 150 times return on investment.

But part of the problem is that value is generated in the future,

but we need the money now to deliver it.

Turns out, this is not a new problem.

Banks have been solving it for centuries.

Simply put, it's called financing.

If you want to buy a house

but you can't afford to pay for it up front,

the bank financiers, you see, can realize that future value now.

In other words, you can live in the house straightaway.

But what if you couldn't?

What if you had to wait until you'd raised all of the money to move into the house,

and you were kept homeless whilst trying to save the money

to get there in the first place?

You'd end up in an impossible cycle, never able to get there,

yet that's this very same bind we've put on ourselves.

Inspired by the change in Botswana

and by the visionary support of our funders and partners,

we've come together -- two world-leading banks,

for-profit and private, not-for-profit organizations,

foundations and philanthropists --

to launch the Vision Catalyst Fund,

a fund which will have trust built in by design.

It will make funding available now

to the organizations that can serve the need of the most vulnerable.

It will ensure that those organizations can work together in partnership,

rather than competing for limited funds,

serving the priority needs of an entire population,

whatever they are,

so that ultimately the individuals affected

can receive the care that they deserve.

And as we've shown,

it doesn't make just a health and social difference,

it creates huge economic benefit.

This benefit in itself will create sustainability

to perpetuate a virtuous, catalytic cycle of improvement and change.

Because when we do this,

the individual needs of people like myself can be met.

And this coalition has come together this year

to make a commitment with 53 heads of government,

who have now committed to take action

towards achieving access to quality eye care for all.

We've had incredible commitments

of 200 million pairs of glasses to the fund

and millions of dollars,

so that the dynamic and individual needs of people --

like my own issues that I had as child,

and like Theresa, who just required simple surgery --

can be met.

For Theresa, it meant her place back in society,

now with her own family and children.

And for Mama Jane, it wasn't just restoring her sight,

it meant the opportunity to restore hope,

to restore joy

and to restore dignity.

(Music)

Thank you.

(Applause)