TED Salon Optum
Andrew Bastawrous: A new way to fund health care for the most vulnerable
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In 2011, eye surgeon and TED Fellow Andrew Bastawrous developed a smartphone app that brings quality eye care to remote communities, helping people avoid losing their sight to curable or preventable conditions. Along the way, he noticed a problem: strict funding regulations meant that he could only operate on people with specific diseases, leaving many others without resources for treatment. In this passionate talk, Bastawrous calls for a new health care funding model that's flexible and ambitious -- to deliver better health to everyone, whatever their needs are.
Andrew Bastawrous - Eye surgeon, inventor
Andrew Bastawrous studies eye health -- and builds accessible new tools to bring eye care to more people. Full bio
Andrew Bastawrous studies eye health -- and builds accessible new tools to bring eye care to more people. Full bio
Double-click the English transcript below to play the video.
00:13
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,
literally, for 10 years,
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because both had gone blind
from a curable condition called cataracts.
from a curable condition called cataracts.
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They hadn't been aware they'd been
sat together for over an hour
sat together for over an hour
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when we offered them surgery
at the nearest hospital.
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,
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.
what she was cooking for him.
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Her arms were covered in burns
from cooking on a charcoal stove,
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
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.
was going through the generations.
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He wasn't able to go to school
or break the cycle of poverty.
or break the cycle of poverty.
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All of this, despite cost-effective
solutions existing.
solutions existing.
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Cataract surgery can be done
in under 10 minutes
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;
who are blind don't need to be;
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curative or preventive
treatments already exist.
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
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,
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
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
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.
it was pretty straightforward.
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But we had strict instructions
that the funds we had
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,
to cover her treatment,
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but situations like Theresa
were common every day,
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.
funding hadn't been earmarked.
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Earmarking may seem like smart business
or smart philanthropy on paper,
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.
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.
to millions of people the world over.
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I've been thinking about this problem
for a very long time.
for a very long time.
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Things happened to me at the age of 12
that completely transformed my life.
that completely transformed my life.
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My teachers insisted
that I would go for an eye test.
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,
brown boy in the school,
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I already felt like
a chocolate chip in rice pudding,
a chocolate chip in rice pudding,
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and the idea of looking more different
was not particularly appealing.
was not particularly appealing.
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You see, I'd associated
an eye test with wearing glasses
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
with the trial lenses
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and was shocked
at just how poor my sight was.
at just how poor my sight was.
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He sent me outside
to report what I could see.
to report what I could see.
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I remember looking up and seeing
trees had leaves on them.
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.
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.
of my life changed.
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I went from a failing child at school
who was constantly told I was lazy
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.
with opportunity and potential.
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But I soon realized that
this opportunity was not universal.
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,
are originally from,
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I was with children that looked
a lot more like me
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?
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
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.
still can't access them.
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This deep sense of injustice
drove me to become a doctor,
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
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
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.
like Mama Jane and Theresa.
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We founded a new organization
called Peek Vision,
called Peek Vision,
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a social enterprise where
we built smartphone technology
we built smartphone technology
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that makes it possible
for people in the community
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,
who are being missed,
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and created new tools that made it
easier to diagnose them
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,
I'd had as a child,
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we equipped teachers,
25 of them, with smartphones
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
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,
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
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
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
was build an incredible team
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who could create the systems
that would change the lives
that would change the lives
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of millions of people,
whatever their needs were.
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,
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,
where your money's going,
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and that trust usually manifests
through the requirement
through the requirement
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to create detailed plans --
lots of paperwork.
lots of paperwork.
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But what happens
if the dynamic needs of people
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?
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,
we should have to make,
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because ultimately,
we can only serve one master.
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.
vulnerable amongst us.
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Currently, the system is not working,
and too many people are being left behind.
and too many people are being left behind.
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We've been fortunate to find
incredible supporters and partners,
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
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.
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,
partners and stakeholders,
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business cases, economic analyses,
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to persuade the government
to eventually come on board.
to eventually come on board.
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But they're now leading and funding this
in their own national budget.
in their own national budget.
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But we did not have
the resources to do this.
the resources to do this.
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Our visionary funders and partners
came alongside us,
came alongside us,
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and the key ingredients were
we were aligned on mission,
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.
what had to be done.
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But critically, they were flexible
and gave us autonomy
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.
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?
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
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.
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
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.
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.
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
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,
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,
to pay for it up front,
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the bank financiers, you see,
can realize that future value now.
can realize that future value now.
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In other words, you can live
in the house straightaway.
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,
all of the money to move into the house,
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and you were kept homeless
whilst trying to save the money
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,
never able to get there,
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yet that's this very same bind
we've put on ourselves.
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,
of our funders and partners,
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we've come together --
two world-leading banks,
two world-leading banks,
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for-profit and private,
not-for-profit organizations,
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.
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.
the need of the most vulnerable.
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It will ensure that those organizations
can work together in partnership,
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,
of an entire population,
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whatever they are,
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so that ultimately
the individuals affected
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,
and social difference,
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it creates huge economic benefit.
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This benefit in itself
will create sustainability
will create sustainability
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to perpetuate a virtuous,
catalytic cycle of improvement and change.
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.
like myself can be met.
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And this coalition
has come together this year
has come together this year
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to make a commitment
with 53 heads of government,
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.
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
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 --
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 --
required simple surgery --
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can be met.
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For Theresa, it meant
her place back in society,
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,
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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ABOUT THE SPEAKER
Andrew Bastawrous - Eye surgeon, inventorAndrew Bastawrous studies eye health -- and builds accessible new tools to bring eye care to more people.
Why you should listen
Andrew Bastawrous is cofounder and CEO of Peek Vision, a social impact organization that uses smartphone technology to radically increase access to eye care in some of the most challenging places in the world. Bastawrous is also an ophthalmologist (eye surgeon) and Associate Professor in International Eye Health at the London School of Hygiene and Tropical Medicine.
Peek's vision app, Peek Acuity, is being used to transform eye health in more than 150 countries. The organization ran one of the top-ten all-time Indiegogo crowd-funding campaigns in the health sector -- for Peek Retina, a smartphone ophthalmoscope -- and was voted "best social-impact start-up in Europe" by Google and McKinsey in 2016. All prize money has been re-invested in Peek.
Bastawrous is working with astrophysicists to crowdsource retinal data; with National Geographic explorers to reach isolated communities; and with artists and activists to advocate for eye care globally. He and his wife Madeleine have established a social enterprise healthy bakery in Kenya that provides employment, with profits paying for eye care.
In 2018, Bastawrous was invited to deliver the Commonwealth Address in the presence of the British Royal Family, where he announced the creation of a new one-billion-dollar Vision Catalyst Fund -- a new vision for international aid.
Andrew Bastawrous | Speaker | TED.com