Peek: building an eye health ecosystem

Did you know?

You will almost certainly be blinded by cataracts, unless one of the following three things happens to you first:

  1. you die

  2. you are blinded by something else

  3. you get treatment

Billions of people don’t have access to treatment, for cataract, or any other vision or eye health problem, so they live with poor vision and blindness needlessly.

Peek helps connect those people to eye health services and expand those services to meet demand.

Eye care is one of the most cost effective medical inventions available to humanity.

To be effective, Peek also needs capacity in those eye health services that is sustained and continuously adopting best practice.

Health services are unequally distributed.

Delivering healthcare to populations who currently lack it involves coordinating the efforts and intentions of:

patients–clinicians–communities–governments–donors–NGOs–academics

We achieved this by rigourously applying:

  1. our platform principles and ecosystem boundaries

  2. against the risks and rewards of each stakeholder partner

  3. within the incentives and controls defined by its partnerships

Peek Vision partner ecosystem

Principles define expectations.

Our principles encouraged partner participation and enabled us to scale our technology and programmes with clinical confidence:

  • do no harm: the first step of Peek’s product and service design is to avoid introducing new harms, or scaling existing ones

  • research based: Peek’s products and services are evidence-based, use published clinical trials where applicable and are rigourously proved in practice before being made generally available for further continuous improvement

  • enabler: Peek acts to enable local practitioners and stakeholders on the ground rather than impose a single standardised implementation

  • paid: Peek does not self-fund its implementations, they must be paid for within the wider context of a fully costed and sustainably funded eye health service

Every research, funding and implementation agreement is made in accordance with these principles, building trust with each existing and potential partner in eye health globally.

Testing a grandmother’s vision with Peek Acuity at her home.

Nakuru County, Kenya, February 2017

photo credit: Tim Carter

Fundamental to Peek’s ecosystem are its boundaries of operation, beyond which partners take responsibility and operate without restriction.

Boundaries define scope.

A major objective for eye health services in under-served populations is to maintain them over time with long term committed funding, policy and government support.

  • delivery: Peek is not a service delivery organisation, it partners with eye health services and specialist international NGOs to implement programmes and services enabled by its technology; this enables Peek to focus on continuous improvement of its technology and scale it to all services globally

  • budget: Peek requires budget commitments from its implementation partners before it will commit to resourcing a service with its own staff for programme research, design, setup, training and support; this ensures that Peek is promoting sustainable healthcare services that truly serve whole populations over time

  • diagnosis: Peek technology enables better and faster diagnosis by specialist practitioners by enabling them to identify and analyse patients with far greater efficiency than before, but it does not suggest a specific diagnosis for any individual patient; this means practitioners are able to make the best diagnosis and prescribe the best treatment that is available to that patient in the applicable eye health service, preserving both patient safety and service integrity

  • non-exclusive: Peek is not a comprehensive set of technologies for every aspect of an eye health service and it does not require exclusivity over those aspects in which it does operate; this means that eye health services can deploy Peek in the areas of greatest need and best fit for its capabilities without compromising existing implementations elsewhere of often fragile services operating at the edge of local capacity

Peek Vision’s partnership structure with funders and academia, 2016

photo credit: Tim Carter

Maintaining a partner-based ecosystem demands consistent exposition and application of principles and boundaries that invite and enable all partners.

This is particularly important when human health and wellbeing is directly at stake, in vulnerable communities where services are stretched to capacity, in relation to complex issues where global agreement on best practice is still developing in reaction to emerging clinical evidence.

In return, all partners benefit from advances in best practice, can leverage the latest scaling tools, and each implementation contributes to the continuous improvement of the whole system.

Celebrating the Government of Botswana’s revolutionary commitment to launch its comprehensive national childhood eye screening service powered by Peek.

(From left to right) Tim Carter, Chief Impact Officer, Peek Vision | Evelyn Brealey, Director, Cambridge Global Health Partnerships | Katharine Ransome, British High Commissioner to Botswana and UK Representative to the Southern Africa Development Community, UK Government | Ryan Littman-Quinn, Director of Health Informatics, Botswana-UPenn Partnership | Shenaaz El-Halabi, Permanent Secretary, Ministry of Health and Wellness, Government of Botswana | Dr Astrid Bonfield CBE, Chief Executive, The Queen Elizabeth Diamond Jubilee Trust | Professor Andrew Bastawrous, CEO, Peek Vision

photo credit: Tim Carter

The Peek-Botswana Implementation Team delivered the pilot for school vision screening, and consisted of optometrists, ophthalmic nurses, Ministry of Health & Wellness Eye Health Unit staff, Ministry of Education staff, and Botswana-UPenn Partnership Health Informatics staff.

(From left to right) Deborah Motsilenyane, Eye Health Unit, Ministry of Health & Wellness | Maipelo Tuelo, Project Manager, Botswana-UPenn Partnership | Faruk Maunge, Regional Planning Officer, Ministry of Education | Thanuja Panicker, Optometrist, Botswana Optometry Association | Keitumetse Thamane, Eye Health Unit Staff, Ministry of Health and Wellness | Ryan Littman-Quinn, Director of Health Informatics, Botswana-UPenn Partnership | Mildred Tau, Ophthalmic Nurse, Ministry of Health & Wellness | Cynthia Mautswe, Staff, Botswana-UPenn Partnership | Jacob Kegakilwe, Ophthalmic Nurse, Ministry of Health & Wellness | Alice Lehasa, Eye Health Unit, Ministry of Health & Wellness | Martin Mahlaka, Optometrist, Botswana Optometry Association | Ditso Oduetse, Ophthalmic Nurse, Ministry of Health & Wellness.

photo credit: Dikai Zambo

Our ecosystem principles and boundaries founded a unique collaboration across academia, technology, government, social funding and clinicians that has changed how eye health services can be delivered.

Peek has gone on to work with partners across Sub-Saharan Africa and Central Asia to screen a million people to date.

Peek enabled the Government of Botswana to launch Pono Yame, the world’s first comprehensive, government-led school eye health programme.

In the process, Peek has helped the international eye health community promote the usage of standardised, clinically proven methodologies by implementing them in new technologies, such as the Rapid Assessment of Avoidable Blindness (RAAB).

First posted: 10 October 2022

All images and text copyright Tim Carter 2022.

All rights reserved.