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

翻译人员: jacks peng 校对人员: Tianji (Homer) Li

These two Kenyan ladies were best friends

这两位肯尼亚女士是

from neighboring villages,

来自临近村庄的好朋友，

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

但实际上，她们已经长达10年没见面了，

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

因为她们都因一种叫做白内障 的可治愈疾病而失明。

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

当我们在最近的医院给她们做手术时，

when we offered them surgery at the nearest hospital.

她们没觉察到她们坐在一起 超过一个小时了，

Mama Jane, on the right, told me

简妈妈，右边那位，告诉我

her biggest fear was that she would poison her grandson,

她最大的恐惧是害怕毒到她孙子，

whom she'd never seen,

那位她看不见的孙子，

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

因为她看不见给他煮的是啥。

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

她的手臂被炭炉煮过的东西烧伤了，

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

她绝望地说，她正在剥夺 她六岁孙子的童年，

because he was effectively her eyes.

因为他实际上在扮作她的眼睛。

The effect of her blindness was going through the generations.

她失明的影响代代相传。

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

他无法去上学或打破贫穷的循环。

All of this, despite cost-effective solutions existing.

所有这些，尽管有效的治疗方法存在。

Cataract surgery can be done in under 10 minutes

白内障手术可以在10分钟内完成，

for just a hundred dollars.

只需要100美元。

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

80%的盲人本可以被治愈；

curative or preventive treatments already exist.

治疗或预防治疗早已经存在。

Fortunately for Mama Jane and her friend,

幸运的是对简妈妈和她的朋友来说，

a donor had provided treatment

捐赠提供了治疗，

so that we could take them to the nearest hospital

所以我们可以带她们到三个小时远

three hours away.

的最近的医院。

But in that very same clinic,

但在同一个诊所，

I met Theresa,

我遇到了特丽萨，

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

一个不敢用眼睛直视我的年轻害羞女性，

not because she couldn't see,

不是因为她不能看见，

but the appearance of the growth on her eyes called pterygium

而是因为她眼睛上长出来的翼状胬肉

meant she'd lost her confidence,

让她失去自信，

and with it, her place in her community.

让她失去在社区的位置。

She had no prospects for marriage or children

她结婚或生孩子无望

and had been completely ostracized.

并完全被人排斥。

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

我知道如何治疗她的问题；这非常直接。

But we had strict instructions that the funds we had

但是我们有严格的规定，我们的资金

were for people with cataracts.

只能用于治疗白内障。

What was I supposed to do?

我应该怎么做？

Ignore her?

忽视她？

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

我妻子和我能募集资金来支付她的治疗，

but situations like Theresa were common every day,

但像特丽萨的人每天都很常见，

where people had the wrong diseases.

在那里人们有错误的疾病。

And by the "wrong diseases,"

关于“错误的疾病”，

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

我意思是资金用途中没有指定的疾病。

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

在纸面上，专款似乎是明智的 商业行为或明智的慈善行为，

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

但当你看着这些人的眼睛时， 它一点都不合理。

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

然而，这就是我们向全世界数百万人 提供医疗保健的方式。

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

我已经思考这个问题很长时间了。

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

12岁那年发生的事情完全 改变了我的生活。

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

我教师坚持要我去参加视力检查。

I resisted it for as many years as I could

我尽可能地拒绝了好多年，

because as the only brown boy in the school,

因为作为学校中唯一一个棕色儿童，

I already felt like a chocolate chip in rice pudding,

我已经觉得自己像米饭布丁 里的一块巧克力，

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

看起来更与众不同的想法 并不特别吸引人。

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

你知道，我把验光和戴眼镜联系起来，

and looking different,

这看着不同，

not with seeing differently.

而非看到不同的东西。

When eventually I was persuaded to go,

当最终我被说服去检查了，

the optometrist fitted me with the trial lenses

验光师给我配了试镜镜片，

and was shocked at just how poor my sight was.

并被我糟糕的视力震惊到了。

He sent me outside to report what I could see.

他让我到外面去报告我所看到的。

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

我记得向上看到了树有树叶。

I had never known this.

我从不知道这个。

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

那个星期晚些时候， 我第一次在夜空中看到星星。

It was breathtaking.

真是激动人心。

In fact, the entire trajectory of my life changed.

事实上，我整个人生轨迹都改变了。

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

我从一个在学校经常被视为懒惰， 无法集中注意力的

懒惰儿童，

and not paying attention

to suddenly being a child with opportunity and potential.

突然变成一个充满机遇和潜力的儿童。

But I soon realized that this opportunity was not universal.

但我很快意识到这个机遇不是普遍的。

That same summer, in Egypt,

同个夏天，在埃及，

the home where my parents are originally from,

我父母的老家，

I was with children that looked a lot more like me

我和那些看起来更像 我的孩子们在一起，

but couldn't have been more different.

但没有比这更不同的了。

What separated us was opportunity.

把我们分开的是机会。

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

为什么我有这样的生活， 而他们有他们的生活？

It still makes no sense to me.

这对我来说仍然很不合理。

How is it we've --

怎么会——

in a world where glasses, that completely changed my life

这个世界中，完全改变我的生活的眼镜

have been around for 700 years,

已经存在700年之久，

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

然而仍有25亿人没法获得他们。

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

这种深深的不公平感驱动我成为了医生，

eventually an eye surgeon,

最终成为一名眼科医生，

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

并在2012年，我妻子和我 打好包袱搬到肯尼亚

to try and give something back.

来试图回馈当地。

We started by setting up a hundred eye clinics

我们开始沿着大裂谷设立

across the Great Rift Valley,

上百家眼科诊所，

where we met people like Mama Jane and Theresa.

在那里我们遇到了像简妈妈和 特丽萨这样的人。

We founded a new organization called Peek Vision,

我们成立了一个叫皮克眼科的组织，

a social enterprise where we built smartphone technology

这个社会企业，通过开发的智能手机技术

that makes it possible for people in the community

来让社区人们

to find people in their homes,

能够发现他们家中

the most vulnerable groups who are being missed,

那些被忽略的脆弱群体，

and created new tools that made it easier to diagnose them

并通过开发新的工具让诊断和获取服务

and connect them to services.

变得容易。

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

受我儿时经历的启发，

we equipped teachers, 25 of them, with smartphones

我们配备了老师，25个人，通过智能手机

to screen children in schools.

来在学校中筛查儿童。

Our first program resulted in 21,000 children

我们的首个项目在只有9天的时间里

being screened in just nine days.

就筛查了21000名儿童。

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

同样的项目被复制到20万名儿童，

covering the entire district.

覆盖了整个区。

Soon we were able to repeat this in six new programs

很快我们就能够在不同的国家

in different countries.

的6个新项目中重复这个过程。

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

但现在，我遇到了跟特丽萨类似的

of earmarked funds,

专项基金的难题，

but now as an organization.

现在是作为一个组织遇到。

People wanted to fund specific projects

人们想要资助特定的项目

or particular diseases

或者特定的疾病

or subsets of the population.

或者特定子集的人群。

But it didn't make sense,

但这点不合理，

because what we needed to do was build an incredible team

因为我们要做的是建立 一个了不起的团队，

who could create the systems that would change the lives

这个团队创建的系统可以改变

of millions of people, whatever their needs were.

数百万人的的生活， 不管他们的需要是什么。

But it didn't work that way.

但事情却不是这样运作的。

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

不久，我们能够与理解的伙伴结盟，

because I understand the challenge.

因为我理解这个挑战。

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

说到底，你需要信任你的钱的去向，

and that trust usually manifests through the requirement

这种信任通常是通过要求

to create detailed plans -- lots of paperwork.

制作详细的计划来体现的 ——数不清的文书工作。

But what happens if the dynamic needs of people

但如果人们多变的需求不符合

don't fit with the plan that you created,

你制定的计划怎么办？

and your funding is dependent on delivering the plan?

你的基金仍然要依赖于完成计划？

You end up with a choice:

你最终得做出选择：

Do you serve the plan, the funder,

你是服务这个计划，你的出资人，

or do you serve the need?

还是服务需求？

This is not a choice we should have to make,

这个选择不应该是我们要去做的，

because ultimately, we can only serve one master.

因为最终，我们只能服务一个主人。

The measure of our humanity

衡量我们人性的尺度

is how we serve the most vulnerable amongst us.

在于如何服务我们中间最脆弱的人。

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

目前，这个系统不奏效， 很多人被抛在后面。

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

我们有幸能够找到 了不起的支持人和伙伴，

which led to a new program in Botswana,

并在博茨瓦纳开启了一个新项目，

in which every single schoolchild is being screened and treated

这个项目是到2021年每个学生都能被

by the end of 2021,

筛查和治疗，

meaning an entire generation of children

这意味着整一代的儿童

will have the opportunity that good vision affords.

都会获得好视力带来的机遇。

But this took years of work.

但这花了好多年的努力。

It took multiple feasibility studies,

它进行了多次可行性研究，

engaging different partners and stakeholders,

接触不同的伙伴和股东，

business cases, economic analyses,

商业场景，经济分析，

to persuade the government to eventually come on board.

去说服政府最终同意。

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

但现在他们在自己的国家预算中 领导和资助这个项目。

But we did not have the resources to do this.

但我们并没有资源来做这件事情。

Our visionary funders and partners came alongside us,

我们富有远见的资助者 和合作伙伴与我们并肩同行，

and the key ingredients were we were aligned on mission,

关键在于我们的使命一致，

on the why we were doing it.

我们做这些事的动机一致。

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

我们对结果，对需要做的事情意见一致。

But critically, they were flexible and gave us autonomy

但重要的是，他们很灵活， 给了我们自主权

to work out how we got there,

去找到如何达到目标，

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

给了我们创造、雄心和冒险的空间。

What if all health care looked like this?

如果所有的医疗都如此操作会怎样？

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

这对我们要解决的社会问题意味着什么？

Business knows this.

商业清楚这点。

By taking a long-term, ambitious view

以长远，雄心壮志的眼光看问题

and giving people the autonomy to be creative

并且给人们自主的创造力

to solve our world's biggest challenges,

来解决我们世界上的最大挑战，

we've disrupted entire industries.

我们会颠覆整个行业。

Look at Amazon, Google.

看看亚马逊，谷歌。

Surely, we need the same level of ambition

显然，我们需要同等的抱负，

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

如果我们要为最弱势的群体服务。

As a planet, we've set a target,

作为一个地球，我们设定了一个目标，

the Sustainable Development Goals,

可持续发展目标，

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

然而，我们在解决全球目标上的支出还没有

than we are on conflict resolution,

我们解决冲突支出的一半，

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

主要是因为我们没有服务的不平等。

It's time for change.

是时候做出改变了。

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

这不仅是常识，在商业上也是合理的。

Our work in Botswana showed

我们在博茨瓦纳的工作显示

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

只需要小的投入，儿童的成人后就能让经济

over the lifetime of the children.

增加13亿美元。

That was 150 times return on investment.

投资回报率为150倍。

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

但部分问题在于 这个价值是未来产生的，

but we need the money now to deliver it.

但我们现在就需要金钱去交付它。

Turns out, this is not a new problem.

事实表明，这不是个新问题。

Banks have been solving it for centuries.

几个世纪来，银行都在解决这个问题。

Simply put, it's called financing.

简单地说，这就叫融资。

If you want to buy a house

如果你想要买个房子，

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

但你无法预先支付，

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

银行的金融家，现在就能够 意识到未来的价值。

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

换句话说，你可以直接住进房子里去。

But what if you couldn't?

但如果你不能够呢？

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

如果你得等你把所有钱都凑齐了 才能住进房子，

并且一开始你就得努力赚钱

and you were kept homeless whilst trying to save the money

却又无家可归呢？

to get there in the first place?

你最终就会陷入不可能的循环， 永远不可能到那，

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

然而这正是我们对我们自己施加的束缚。

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

Inspired by the change in Botswana

灵感来自于博茨瓦纳的变化

and by the visionary support of our funders and partners,

以及资助者和合作伙伴的远见支持下，

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

我们走到了一起，两家世界领先的银行，

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

营利性和非营利性组织，

foundations and philanthropists --

基金会和慈善家，

to launch the Vision Catalyst Fund,

发起了视力促进基金，

a fund which will have trust built in by design.

一种设立之初就建立信托的基金。

It will make funding available now

现在，它将能够向

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

满足最脆弱群体需求的组织提供资金。

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

它会确保这些组织可以通力合作，

rather than competing for limited funds,

而不是竞争有限的基金，

serving the priority needs of an entire population,

服务整个人类的优先需求，

whatever they are,

不管它们是什么，

so that ultimately the individuals affected

这样最终受影响的个人

can receive the care that they deserve.

可以得到应得的照顾。

And as we've shown,

正如我们所展示的，

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

这不仅对健康和社会有影响，

it creates huge economic benefit.

它创造了巨大的经济效益。

This benefit in itself will create sustainability

这个效益本身会保持

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

一个良性的循环， 催化提升和改变的循环。

Because when we do this,

因为当我们做这些了，

the individual needs of people like myself can be met.

像我自己那样有需要的 人们的需求就可以被满足。

And this coalition has come together this year

这个联盟今年走到了一起

to make a commitment with 53 heads of government,

让53位政府首脑作出承诺，

who have now committed to take action

他们现在承诺采取行动，

towards achieving access to quality eye care for all.

为所有人提供高质量的眼部护理。

We've had incredible commitments

基金收到了难以置信的

of 200 million pairs of glasses to the fund

2亿副眼镜的承诺

and millions of dollars,

和数百万美元的资助，

so that the dynamic and individual needs of people --

所以个人不同的需求——

like my own issues that I had as child,

比如我还是孩子时遇到的问题，

and like Theresa, who just required simple surgery --

以及像特丽萨，只需一个简单手术的人——

can be met.

可以被满足。

For Theresa, it meant her place back in society,

对特丽萨，这意味着她社交的回归，

now with her own family and children.

现在已经有了自己的家庭和孩子。

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

而对于简妈妈，这不仅 只是恢复她的视力，

it meant the opportunity to restore hope,

这意味着恢复希望，

to restore joy

恢复欢乐

and to restore dignity.

和恢复尊严的机遇。

（音乐）

(Music)

Thank you.

谢谢。

(Applause)

（鼓掌）