Transforming the Vision of a Population
At the tender age of 12, Dr Andrew Bastawrous perceived the injustice of a world where millions of people suffer preventable vision loss because they don’t have access to eye care. He shares with us how his interest grew from helping individuals as an eye surgeon to helping whole populations with his social enterprise, Peek Vision.
A medical doctor, academic and co-founder of a social enterprise with a raft of accolades to his name, Dr Andrew Bastawrous’ life could have turned out very differently if he had lived in another country.
"I had very poor vision as a child and I was doing really badly at school”, he recalls. Andrew’s family are from Egypt and on their annual visit when he was 12 years old, he started noticing the poverty and lack of access to basic things he took for granted.
“I also noticed that nobody else was wearing glasses and it suddenly sunk in that the world was an incredibly unfair place”, he says.
With the removal of a barrier that could have limited his academic progress and fuelled by his experiences, Andrew excelled and went on to study medicine, eventually becoming an eye surgeon.
After several years, Andrew realised he could have an even bigger impact. “I could zoom out further, see the whole problem, understand the real barriers and find different ways of dealing with it”, he explains.
When you see someone who’s been blind five to ten years unnecessarily and then the next day - because of a role we’ve had supporting our partners - that person has been found and treated and got their sight back and with it, their life back, that can really fuel more of what we’re doing.
The foundations of Peek Vision were laid as Andrew’s perspective shifted from treating individuals to caring for whole populations, which uncovered a range of barriers that his team would have to overcome.
“They can be summarised as ABCDEFG”, he says. These stand for awareness, bad services (people end up at the wrong or an under-resourced service), cost, distance (most doctors are in towns, but the need is greatest in rural areas), escort (people need someone with them which isn’t accounted for by services), fear and gender (women are most affected by all the barriers).
Understanding and developing a solution to these barriers was Andrew’s focus from first concept in 2010, to proof of concept in 2012 and a funded research project in 2014, before spinning out of the London School of Hygiene & Tropical Medicine in 2015 as a social enterprise with a team of seven.
Having grown the team to 35 based in London, Kenya and Botswana, Peek Vision blends partnership working with technology. The team are working on projects in Botswana, Kenya, Nepal, Pakistan, and Zimbabwe.
Andrew explains: “We have developed various smartphone-based tools that allow non-eyecare professionals to do professional eyecare examinations, including taking vision tests and images of the inside of the eye.”
With the extra resource created by enabling non-specialists to do screening, the team achieve a much greater reach into the community and can identify and refer people who need treatment to partners.
It’s usually the story of an injustice that will align everyone around you - your team, potential sources of funding, your business model, your entity set-up, structure… all of that should be formed on why you’re doing it.
Peek Vision use data generated from the smartphone assessments to build a real-time picture of the health system, create benchmarks of where they’re starting from and assess the improvements each system makes.
“We can see where the biggest gaps are in the system, giving the local partners and service partners the information they need to reach more of the people who need it”, Andrew explains.
Despite the technology being the most visible part of what Peek Vision does, Andrew says most of the work is in the design process. He explains: “Whenever we’re starting somewhere new, we’ll first identify is there a need, who are the existing stakeholders, who is already working there to try and meet that need and then look at designing an approach which means everybody can work together collaboratively to meet more of the need.
“Because we’re treating a population and not a disease, that population will have a range of needs from cataract surgery, to glasses, to eye drops. We will identify who all the existing partners are that provide those types of care and then we make sure we are effectively funnelling the people who need those services to the right partners.”
It requires careful management to ensure that the different partners can cope with the number of people Andrew’s team send. There is also the people who pay for services – individuals, the government, non-governmental organisations (NGOs), donors and insurance services. All must be consulted and considered in the service design stage and throughout Peek’s operations. “It’s never straightforward - and never boring either”, Andrew laughs.
Clearly, he’s learned many lessons. “It always takes longer than you expect. Looking back things may look like they’ve happened quickly but going forward it always feels like it’s going too slow”, he says.
He continues: “In many ways, it’s been much harder than expected, but we don’t really look at things in that way. It’s always been a focus on where are we going and progress, but with that comes all the challenges of working in a growing team. I think those elements have been hard, and the pressure that comes with raising money and supporting a constantly changing team and product is very difficult, but equally, it’s all worth it because of why we’re doing what we’re doing.”
Andrew is refreshingly honest about the challenges of the social enterprise model. “I would say it’s hard to make money and do good but it’s certainly not impossible”, he says. “For the last five years we have been primarily funded through grants and donations, but now we’ve developed more of our services and products we’re in a position where we can start charging our partners such as governments and international NGOs for our services.”
The organisation is currently about 50% funded and is working towards becoming self-sustaining from earned income, which Andrew expects will take about three years. Alongside this, he says, “we will be increasing the number of partners we’re working with, delivering multiple projects in parallel and refining the way we deliver them, so they become less resource-intensive and we can generate more of a margin that we can use to support more work.”
In the meantime, one of the challenges Peek Vision faces is securing the right balance of funding types.
Andrew explains that most funding focuses on projects, where money is granted or donated for an organisation to deliver specific activities - often in a given geography, within a specified timeframe or with particular partners. Only costs directly associated with the project delivery are covered.
Core funding supports the overall mission and team of an organisation. It covers things like strategic planning, training and process optimisation for the business, as well as delivering multiple projects in line with the mission. It is this kind of funding that Andrew says needs to increase in the sector – something he clearly feels strongly about and is actively working to address.
“If you look in the for-profit sector, that’s exactly how the big venture capitalists fund - they don’t fund projects - they fund teams and ideas”, he says. “There are people who are starting to take that approach. But I think the challenge from a donor perspective is it’s much harder to attribute your funding if it is not to a given project or thing. You know if you’re paying for a hospital, or a thousand people to be treated, that’s more tangible. But if you’re making a donation for a team, and that money is spent on salaries, training and capacity building the impact that has is indirect, so attributing it to the money that’s gone in is much harder.”
Despite these challenges, Andrew and his team continue to be driven by seeing individuals’ lives changed. “When you see someone who’s been blind five to ten years unnecessarily and then the next day - because of a role we’ve had supporting our partners - that person has been found and treated and got their sight back and with it, their life back, that can really fuel more of what we’re doing. And yet at the same time, the knowledge that there are so many more people who have still not had that opportunity - that’s the thing that gets everyone out of bed in the morning and working harder and harder to address this,” he says.
Andrew’s advice for aspiring social entrepreneurs is “to be absolutely clear on why you’re doing what you’re doing and be able to articulate that very clearly. It’s usually the story of an injustice that will align everyone around you - your team, potential sources of funding, your business model, your entity set-up, structure… all of that should be formed on why you’re doing it.
“How you do it is the bit that’s changing and evolving on a rapid basis. It’s really important to have flexibility because if you hire brilliant people then you need to give space and creativity to solve very difficult problems.”