Peek Vision, making the invisible, visible in eye health

1.1 billion people worldwide live with untreated vision loss; by 2050 this figure is expected to rise to 1.8 billion. Simple, cost-effective treatments exist. But eye health organisations in low and middle income countries work tirelessly with lean resources. Specialists are in short supply. Programme impact data arrives late. Those with unmet needs remain invisible to health systems.

Conservative estimates suggest that global productivity loss from vision impairment is approximately 411 billion USD annually. The Lancet Global Health Commission on Global Eye Health established a clear link between sight and many of the Sustainable Development Goals. This was reinforced by the first ever UN General Resolution on Eye Health,  passed in July 2021, enshrines eye health as key in achieving the United Nations’ Sustainable Development Goals.

Improving eye health is a practical and cost-effective way of unlocking human potential. Scientific research in rural India demonstrated that glasses can boost worker productivity by over 21%, representing one of the largest ever recorded productivity increases from any health intervention.

A global study by PwC demonstrated that, for every GBP 1 invested in eye health care, GBP 5 is returned. The Global Commission on Eye Health, and several other corresponding studies have proven that correcting vision significantly improves education outcomes, lifts people out of poverty, makes our cities safer and empowers marginalised communities.

The two most prevalent eye conditions, refractive error and cataracts, can be solved with a simple pair of glasses or a low-cost, quick operation. The investment needed is therefore not in developing new treatment solutions but in innovating the delivery of eye health to ensure every person has access to the treatment they need. Something urgently needs to be done to make the invisible, visible in eye health, and turn the tide of avoidable vision loss.

Peek Vision is a social enterprise that powers eye health programme providers to strengthen systems & service delivery with a software & data intelligence platform. We provide our partners with tools to reach more people, with better efficiency, to make the invisible, visible.

Some of our key offerings are:

• Strong Evidence Base: We have conducted six research programmes reaching over 225,000 people across three countries and resulting in six research papers published (three in the Lancet family of journals) validating the impact of our software and approach. There are another 20+ scientific articles on elements of Peek.

• Peek Acuity: A clinically validated distance vision testing app (Peek Acuity) which is free to download on the Google Play Store. It has been downloaded in over 190 countries. 

• Peek Surveys: Impactful programmes begin with understanding people’s eye health needs. Peek powers the latest version of the globally-recognised Rapid Assessment of Avoidable Blindness (RAAB7) adult eye health survey. We are developing a similar tool for school aged-children.
• Peek-Powered Programmes
  • Unique Methodology: We are outcome-focussed and enable our partners to measure and monitor the metrics that matter in eye health. 
  • Software: Our unique software for community and school eye health programmes powers screening, data capture and analysis. A combination of Peek Acuity (mentioned above) and a powerful data capture and live tracking software that can be integrated into other health systems and used for real-time data analysis. 
  • Services:
    • Programme Design: Our team of experts help our partners to create programme targets and workflows that fit the needs of their population and use resources effectively.
    • Expert Data Analysis and Insights: Real-time data insights and frequent evaluation enable services to continuously improve and ensure nobody is left behind.
    • Training, Support and Data Processing: We offer comprehensive training and support as well as industry-leading data security and processing standards.

A Peek-powered programme, our primary market offering, is designed to enable non-specialists to conduct large-scale eye health screening in schools and communities.  Patients requiring specialist review are identified and referred for appropriate treatment. Patients and/or carers receive automated text or voice messages in local languages notifying them of results and actions. Results are sent to local programme managers, head teachers and/or appropriate professionals to facilitate coordination of necessary actions (e.g. appointment booking; organising group local transport). Crucially, “loop-closure” is tracked in real-time with live data to close the huge gap in the proportion of people identified with an eye health need who never make it to treatment, which can be as high as 80-90%.

Our partners use Peek’s software and data intelligence platform and comprehensive approach to identify hidden barriers to eye health across their programmes. By uncovering these hidden barriers we are enabling system-level changes which make our eye health systems more impactful, cost-effective, efficient and equitable. 

Another advantage of Peek is how it contributes to making the most of limited and unevenly distributed human resources. Peek makes it easier to decentralise the screening activity, which can often be a bottleneck. By training teachers and community members to conduct screenings in schools and communities, services can be brought closer to the people with eye care conditions. Patients can be referred to primary health centres, thereby reducing the burden on specialists’ time at secondary and tertiary centres. For example, in Zimbabwe, our partners implemented changes in their referral practices in response to data from Peek and as a result, cataract cases have increased from 30% to 50% of the hospital case mix. This is good news as it indicates a positive shift reflecting more appropriate use of specialists’ time.

Of the 1.1 billion people living with untreated visual impairment, 90% live in low- and middle-income countries. Peek serves these people.  To operate at scale and in some of the hardest to reach places, Peek works with governments, INGOs and implementing partners, assisting them to accelerate their community and school eye health programmes, efficiently and equitably.

Peek’s partners - those responsible for eye health in their regions - aim for universal coverage in their programmes. They will likely identify  target populations (e.g. elderly women; people living x miles from the nearest village; school age children) who are often left behind and Peek can help them to do so. . For Peek, the number of people screened (i.e. coverage) and the number of those screened who are referred and connected to care are who we count as our beneficiaries. Our software enables our partners to breakdown their beneficiaries by location/gender/age and other social demographics to analyse which sub-sets are reaching, and not reaching, the care they need.

We are providing organisations across the world the tools and actionable insights to monitor patients’ journeys to care, address barriers and increase efficiency and equity of programmes. Our vision-testing app is putting eye health directly into the hands of communities across Africa and Asia by enabling non eye health specialists, like specially trained teachers or Lady Health Workers, to screen for eye conditions.
Our partners use Peek’s software and data intelligence platform and comprehensive approach to identify hidden barriers to eye health across their programmes. By uncovering these hidden barriers we facilitate  system level changes which make eye health systems more impactful, cost-effective, efficient and equitable.

Many people who have an unmet eye health need start the care journey but fall out of the system before they are treated. With Peek, programme managers can identify points along the health journey where patients are lost and then by making adjustments to the programme, they can monitor the effect of these changes. This enables eye health managers to ‘see’ those who are being missed and to trial different approaches, observing the results of these approaches in real-time.

We take a collaborative approach to our solutions. Every programme and its data is owned by our partners. Our role in the solution is to provide the software, methodology, data intelligence and actionable insights to help our partners improve their programmes.

When a barrier to care is identified in the data, the Peek team and all local partners work together to find a solution, which involves consultation with the local communities to understand why they are not reaching care.

For example, Peek is powering is a programme in Tanzania, coordinated by CBM Christian Blind Mission (CBM), in partnership with the local hospital, Kilimanjaro Christian Medical Centre (KCMC) and the local government. It aims to bring sustainable eye health to rural communities. The project has trained 60 government-funded primary health workers to use Peek for screening and referral. They are also trained to treat basic eye conditions, bringing access to eye health into the community, reliably and sustainably.

The programme has made significant improvements to encourage people to reach the treatment they need. They are using Peek to understand the barriers to care, and collaborating to find solutions to these barriers, as the KCMC Programme Coordinator, Philip Bahati, explains:

“We meet regularly with government officials, CBM and Peek to go through the programme data. The results of these discussions have been transformative for our programme. What we think may work in programme design, doesn’t necessarily translate into real life. Having the data at our fingertips helps us to finesse these problems.”

The programme’s initial target was to reach 208,000 people over a 2 year period. However screening coverage was low. Lack of awareness that screening services were available locally was identified as a primary reason for the low turnout. To combat this, the programme team encouraged the government health workers to go to community settings such as churches and mosques to increase screening. This has led to a significant monthly increase in those reaching care. In Q1 2022, 5,466 people were reached.  In Q2, 2022, the number reached in that quarter more than quadrupled with 26,091 people reached.

The programme also struggled with patients reaching their referral appointments. By introducing this programme to rural areas patients can access screening services locally - but the distance to regional hospitals is still a major barrier for many to reach specialist care. To combat this the team has introduced a transport service to pick people up when enough people in a health centre catchment area have been referred. As a result there was an increase in those connected to care from 59% in April to 84% in June.

Peek’s is made up of a multidisciplinary team of outstanding individuals recruited from a diverse range of backgrounds. We have an office in Gaborone, Botswana and other team members are remotely based around the world (including Ghana, Kenya, Pakistan, the UK, Spain, USA and Slovenia). 

The CEO and co-founder of Peek Vision brings a lived experience of being vision impaired (high myopia) and understands first-hand the transformative impact of receiving vision correction. He is a fully qualified Ophthalmologist and has a PhD in public health and holds a Professorship in Global Eye Health at the London School of Hygiene & Tropical Medicine. He has undertaken research in over twenty countries including two years living in Kenya where he led a major eye disease study and the development and testing of Peek.

In our programmes and research & development teams, we have public health experts, as well as two optometrists and an ophthalmologist. Our programme staff, almost exclusively based in Africa and Asia, have extensive experience in delivering impactful development programmes. They bring a wealth of knowledge as well as valuable networks.

For example, one team member is Dr Hillary Rono PhD. He is one of a minority of ophthalmologists in Kenya who has chosen to work in the public sector in a rural area.  He leads Kitale Eye Unit, a specialist eye health centre located 400km from Nairobi.  In his work as an ophthalmologist, Dr Rono faces similar challenges to any eye care specialist working in a low-resource, rural setting.  He is the sole ophthalmologist serving a huge patient population - around 2 million people.

As an organisation committed to learning and growth, continuous improvement, and ongoing development, we are excited to think of the opportunities that the Solve Challenge could make available to Peek. In particular, we can identify a few key areas:

Financial barriers/opportunities: We have a strategy to achieve our vision and we are clear on the incredible impact it could have on the world. We also believe that we can scale our model sustainably through social franchising, but this is uncharted waters for Peek. Furthermore, we are aiming to eventually sell our software and solutions to governments - a complex target market. We have an excellent team, a savvy Board and a unique structure, which help to set us up for success. We would welcome the financial backing as well as the commercial expertise in the Solve network to help us tackle the challenges and make the most of the opportunities. 

Technical barriers/opportunities: Our focus over the next two years is to go from a ‘high touch, low volume model’ to a ‘low touch, high volume model’. We will do this by: 1) Building more functionality into the software (e.g. certain data analytics currently done manually by our team), and make our software as easy to use as possible; and 2) Building capacity by certifying partners to train other partners to use Peek. These improvements will require significant investment from our team to develop and build upon. Potential funding, additional targeted capacity and pro bono expertise would be invested to enable Peek to become an ‘out of the box’, incredibly powerful, data and technology-led solution for eye health programmes the world over. 

Organisational Operations: we are at a point in our journey where we are transitioning from “selling the vision” to “selling the product” which requires a different mind-set and way of working. We are actively exploring how to do this well without compromising the soul of the organisation. Expert facilitation in this area would be gratefully appreciated.

We have recently completed a return on investment study with our anchor partner CBM. We compared two CBM programmes that were not using Peek to two programmes that were, in the same country and in the same time period. It was found that with the Peek-enabled programmes, 16x more people reached care and it was almost 7x cheaper than the non-Peek-enabled programmes. 

If applied at scale, we believe that Peek’s solutions will completely transform the eye health sector. Currently, rates of blindness are growing exponentially across the world, in spite of there being simple solutions to over 80% of those living with vision loss. If we reach the level of impact we are aiming for we believe governments will be able to actively reduce their rates of blindness. 

This requires a system-level change in how eye health services are provided. Peek provides key components to implement this change. Our rich body of evidence, including the recent ROI study with CBM, has proven beyond doubt that our solution works and has the potential, when working with the wider sector, to catalyse the change necessary to rid the world of avoidable blindness.

We are unique in three key areas:

1) Software and data intelligence platform designed for eye health, by eye health experts.

Peek is unique in that it gives planners and managers the data and evidence to continually improve and strengthen their programmes through responsive actions made to mitigate where people are being missed or lost in the health pathway. The live data insights allow for quick responses, in contrast to the longer cycle of reviewing programmes at points during the programme cycle.

2) Comprehensive approach that supports programmes from planning through to evaluation.

Peek’s process – from population surveys to programme design to insight generation means that programme managers finally have the ability to track participants through an entire system, seeing how, where, and why they may not access eye care. We encourage collaboration from service providers across the whole journey of care, including governments.

3) A proven solution that is built on rigorous scientific evidence.

We have developed a compelling body of evidence, undertaken in collaboration with the London School of Hygiene and Tropical Medicine, proving that Peek works. Research published in JAMA Ophthalmology in 2015 shows that Peek Acuity, our smartphone-based vision test, is at least as accurate as conventional distance vision checks when used by non-specialist community health workers. Eye health programmes powered by Peek have been evaluated in randomised controlled trials, showing excellent results and published in Lancet Global Health and Lancet Digital Health. Our CEO has published over 80 peer-reviewed articles.

There is a clear link between sight and at least 8 SDGs (1, 2, 3, 4, 5, 8, 11, 17). In particular, Peek’s greatest contributions will be to SDG3 (health), SDG4 (education), SDG8 (decent work and economic growth).

In many eye health programmes, success is measured by the number of people who are screened or treated. Although this helps to understand the level of activity, it doesn’t tell the whole story. What happens to the others? Peek focuses on three ‘metrics that matter’: met need, unmet need, barriers to care. With Peek, partners monitor patients’ progress from unmet need to met need and expedite this process by identifying and finding solutions for barriers to care. We do this by monitoring - and aiming to increase - the following:

• Coverage of a target population (screening coverage)

• Adherence of those with an unmet need who get connected to care (adherence to treatment) 

• Effectiveness of those who have been connected who receive effective treatment (effectiveness of treatment). 

This approach will ultimately have the greatest impact in helping our partners to achieve universal eye health coverage.

Alongside our partners, we advocate for governments to actively invest in eye health. With Peek they can power eye health services more efficiently and equitably as part of their national health plans. In the medium term we will work with the leading eye health INGOs to strengthen and build connected eye health referral pathways across low and middle income countries, and gather the necessary data to advocate for eye health to be integrated into government services. 

Our aims for our 2022-2024 strategy are listed below (with 2022 goals included in brackets):

1. Get it out there: Work with our partners to deliver 100+ programmes powered by Peek across 15+ countries.

2. Connect to care: Each programme will show an increase in the percentage of those being connected to the treatment they need.

3. 'Users love it': Improve the quality and experience of our products by establishing a satisfaction baseline and improving on it each year

4.Make it sustainable: Improve our sustainability by increasing our sales income (by increasing the volume of programmes powered by Peek) and reducing expenditure per programme.

5. Get government backing: Reach a high level of regional or national scale  in at least five countries.

To achieve these goals we have 4 key priorities for investment, our ‘accelerators’:

• Automate: Build more of our analysis and other services into our software to make it a more powerful tool for enabling change

• Replicate: Reduce the services delivered by the Peek team by establishing a replication model to build local capacity (a social franchise model)

• Advocate: Increase advocacy and marketing efforts to secure Peek adoption by governments and INGOs.

• Activate: Ensure population eye health surveys more intuitively go from survey to service, providing eye health leaders with the necessary knowledge and data to plan effective, evidence-based programmes that meet the needs of any given population.

1. Get it out there: We have a live count of the number of programmes we are powering and the facilities they have connected within a target area (we aim for all facilities to be connected). Our aim is 100 programmes by 2025. We also measure the number of people reached in a programme. We believe that by 2025, Peek can be powering partners to see 4 million people per year.

2. Connect to care: We measure the number of people identified with an unmet need and the number of people connected to care in every programme. Our aim is for each programme to improve by their baseline ‘connected to care’ percentage by 15% by 2025. Their baseline is being set this year. 

3. Users love it: We are currently building the product team necessary to measure our user experience and they will set the baseline by early 2023. We seek to improve on this baseline by 15% by 2025. 

4. Make it sustainable: In 2022 we project we will have 43% sales income, by 2025 we aim for this to be 70%

5. Get government backing: We measure this by the number of governments who have invested considerable resources into Peek-powered programmes or our direct customers. We currently have the backing of 2 governments (Kenya and Botswana), with regional backing in Pakistan. We aim for 5 by 2025.

Our theory of change, outlined below, has been established after almost a decade of research into our methodology with several peer-reviewed journals and practical application which can attest to the power of our intervention if applied at scale. This was developed in collaboration with the wider sector and in consultation with several partners and other stakeholders. 

PROBLEM: 1.1B people worldwide have vision loss; 43M are blind. Simple, cost-effective treatments exist. But eye health organisations work tirelessly with lean resources. Specialists are in short supply. Conventional screenings are error-prone. Programme impact data arrives late. Those with unmet needs remain invisible to health systems.

PEOPLE (Who we serve): Eye health programme providers including NGOs & government ministries (our customers) plus implementing partners (our users).

PURPOSE: Our purpose is to Make the invisible, visible.

COLLABORATORS (Other organisations helping us serve our “people):

1. Eye health professionals striving to serve everyone with an unmet vision need.
2. Ecosystem partners for eye health advocacy.
3. Governments for expertise, policy influence, access & authority.
4. Research institutions to validate & advance Peek solutions.

INTERVENTIONS (Our Activities):

Our solutions for school & community eye health providers:

1. Population-level eye health surveys.
2. Programme design.
3. Software.
4. Data insights.

RESOURCES (The resources we need include):

1. Research & evidence.
2. Philanthropic funding.
3. Intellectual property.
4. Experienced staff.
5. Established brand.

BEHAVIOURS (“People’s” actions that need to change):

1. Customers secure the necessary budgets to adopt Peek’s continuous improvement approach.
2. Users utilise Peek solutions to understand local eye health needs & deliver appropriate eye services that are continuously improving.

BIG IDEA (What makes our model different or better):

Optimising eye health screening & referral pathways to ensure no one is left behind.

MISSION (What we are and what we do):

We are a social enterprise that powers eye health programme providers to strengthen systems & service delivery with a software & data intelligence platform.

SHORT-TERM OUTCOMES (What we need to achieve in the short-term):

1. Increased screening coverage: how many more are identified?
2. Greater adherence to referral: what is the increase of the proportion that make it?
3. Increased effectiveness of service: for what increased proportion has treatment worked?

OUTPUTS (Actions or items that contribute to achieving our outcomes):

• Software & methodologies that connect people to care and leave nobody behind.
• Quality user-led programmes that are quick to deploy.
• Insights and learning that lead to change in how resources are allocated.

PATHWAYS (how we will drive impact):

• Scale: external replication, e.g. social franchising or government adoption.
• Systems change: policy, advocacy, changing structures/root cause.

LONG-TERM OUTCOMES (What we need to achieve in the long-term):

1. Efficiency: increased capacity of eye care providers to manage limited resources.
2. Equity: increased access to eye care.

AUDACIOUS GOAL (Our 30-year ambition):

By 2050, together with our “people and “collaborators” we see a reverse in the global trend & prevent 1.25 billion people from untreated vision loss.

VISION (Our ultimate desired end state): Vision & eye health for all.

Peek Acuity is a clinically validated smartphone app which was designed for use in the hands of anyone who could use a smartphone and anywhere in the world (even areas with no internet connection). Our initial randomised control trial of Peek Acuity compared the app to two traditional chart tests - the Snellen chart and the “gold-standard” in eye health testing, the ETDRS chart. We compared the ‘test-retest variability” (i.e. if you do the test today and tomorrow you would expect the same results). The trial concluded that Peek was not only as repeatable, if not more repeatable, than the two charts, but that it was also quicker to deliver than both of those. 

Peek Acuity has since been released in over 190 countries as a certified application on the Google Play store and has been utilised by many others and referenced in other papers. This includes the Journal of Telemedicine and Telecare which did a systematic review that concluded of the highest quality vision-testing apps, the best reproducibility and correlation with in-clinic acuities measured were found using the Peek Acuity application. This was comparing 14 different digital visual impairment tests.  We do not track exactly who is using this free resource, though we can monitor where it is being downloaded and most active. We do know, from sector news/relationships as well as academic papers, that it has been used in several eye health programmes across the world. 

However, our primary market offering, and where we believe Peek holds its most transformative power, is in our ‘Peek-powered programmes', which are a combination of software and services for eye health providers.

Our software includes:

• Peek Capture, which is a combination of Peek Acuity and further data capture and tracking capabilities. It can be used by anyone with minimal training (a 1-week workshop) to test for vision, massively freeing up specialists’ time in under-resourced areas. Each person identified with needing care is automatically referred and sent SMS reminders of their appointments. When screeners are back in internet-connected areas they can sync their devices, where all patient data is fed in our data-tracking portal.
• Peek Admin, our data-tracking portal, is a tool used by programme managers in local teams alongside Peek Vision programme leads and data analysts. It collates all data from a programme and enables a live understanding of where there are people not reaching care. It offers a full demographic breakdown, tracks each individual’s journey and sends managers notifications as to where there are barriers or where screeners may need their assistance. More is being optimised and built into this as we learn from our partners' programmatic needs. 

Our services include: 

• Intelligent programme design involving all stakeholders necessary to link up the region’s eye health system. 
• Regular analysis of the programme to spot barriers to care and inefficiencies in a programme. We provide monthly reports and iteration reviews to help our partners focus on the outcomes that matter. 
• Training on how to use the Peek software (and soon, how to undertake our services themselves).

We support programme design based on principles that drive equity and use data responsibly:

• No screening without service. We support referral pathways so those identified as needing a service can be referred on to treatment. We will not work with partners that can’t offer the full journey to care.
• Minimal data to close the loop. Capture data only for those identified with a need and in order to help them reach treatment. The data gathered in Peek-powered programmes is fully owned by our partners.
• Improve continuously. Review patient journey data regularly for faster, evidence-based cycles of improvement
• Use data to support, not police. Review data collaboratively to improve based on shared learning rather than targeting performance

Peek Vision is also powering eye health Surveys.  These are used prior to or alongside a Peek-powered programme to understand population-level rates of blindness and other data. The Rapid Assessment of Avoidable Blindness (RAAB) makes up around 50% of the eye health data globally and informs governments on where to invest in priority areas. The most recent version of RAAB (RAAB7) is fully digital and powered by Peek. We are also developing a similar survey for use in schools.

The primary data collectors are screeners and health care workers either employed by the government of the target area or by organisations who are partnering with Peek to implement their eye health programmes. Their incentive for screening is normally built into their role. For example in Tanzania, the screeners using Peek are government community health workers who have been trained on eye health as well as many other general health care issues. The wider programmatic incentives for gathering this data is to enable our implementing partner programme managers to collaborate with Peek to identify barriers to care and address issues and to report/advocate for investment in eye health using the data. 

 As part of our social franchise model development, we are looking into how to better incentivise eye health programmes and their screeners/providers.

Our Team

Peek is a fast-paced, constantly changing, boundary-pushing organisation. We are not content with the status quo and together have an exceptional team representing the best of public health research, product design, business management, software architecture and communications. Our diverse team brings together dynamic, experienced and committed people from across the globe. We advertise and recruit globally and have many colleagues located in the countries where Peek-powered programmes are implemented including Botswana, Ghana, South Africa, Kenya and Pakistan. 

Peek prides itself in being gender equitable, with a Leadership team of 3 women and 2 men from diverse cultural backgrounds with wide-ranging experience.  We have a policy of no ‘manels’ (male-only panels) to promote gender equity within the sector. 

We have policies to reflect our values which include, a global family policy enabling families to spend quality time together when a new family member is welcomed, a breastfeeding policy to support women who return to work from maternity leave and who are breastfeeding their child. 

We take measures to ensure against discrimination in employment, recruitment, advertisements for employment, compensation, termination, promotions, and other conditions of employment against any employee or job applicant on the bases of age, disability, gender, marital status, parenthood, race, religion or belief, sex, sexual orientation, or any other factor which may be deemed discriminatory.

Programmes:

Equity is at the core of what Peek does best. In many eye health programmes, success is measured by the number of people who are screened or treated. Although this helps services to understand how an eye health service is performing, it does not tell the whole story. We help our partners focus on the ‘metrics that matter’ in eye health:  unmet need, met need, and barriers to care. These translate into measurable attributes of a service which our partners can focus on when using our solutions and ensure we are making those typically left behind, ‘visible’ to our partners and easily tracked to their care. 

We enable our partners to collect and analyse data on multiple demographics, such as age, gender, and distance from the health facilities. Our live analysis tools help our partners see immediately where there are potential gaps in service. For example, we recently corrected a gender gap which saw an 18/82 split to a 41/58 split in Pakistan.

Peek powers eye health programs, particularly in the hardest to reach areas through insights gained from our data intelligence platform. With Peek, eye health organizations, including Ministries of Health can optimize eye health screening & referral pathways to ensure no one is left behind.

RESOURCES (the key resources we need to run our activities are:):

1. Research & evidence
2. Philanthropic funding
3. Intellectual property
4. Experienced staff
5. Established brand

PEOPLE (our partners and collaborators):

Our key partners and stakeholders are eye health organisations and national governments across low and middle-income countries, as well as the wider eye health sector and the beneficiaries they serve. We work collaboratively with local implementing partners.

COSTS:

• Human resources. As we scale we are not planning to grow our team significantly, but to build a social franchise model whereby our team transfer the knowledge required to implement Peek-powered programmes successfully to local partners. Particular investment is needed to develop our social franchise model and our software. 

• As we are a learning organisation we do seek value in enlisting help from consultants in key areas (currently in our brand and positioning and in our social franchising).

ACTIVITIES (including non-programmatic activities):

• Programme design and data analysis
• Training on how to use our software and conduct our services (such as data analysis) and customer support 
• Product development, user-experience design and quality testing
• Research and development into bettering our methodology and technology. We hold the attitude that ‘better never stops’ and are constantly looking to improve on our solution to best serve our customers, doers and beneficiaries.
• Data security and risk management to ensure we are providing a secure, high-quality product. We are ISO 27001 certified and GDPR compliant.
• Financial control and other resource management, especially ensuring our remote team have opportunities to collaborate and are well supported 
• Marketing, fundraising and advocacy efforts

TYPE OF INTERVENTION: Our intervention is a combination of software and services which are optimising eye health programmes to deliver more equitable and efficient services and to make the invisible, visible in eye health. 

CHANNELS: The majority of our end users are reached through our implementing partners. These implementing partners are typically financed through our customers. Our customers are, mostly, bigger eye health INGOs such as CBM who are financed through individual donors, institutional funding and other sources. Eventually, we hope that our customer base will also include Governments (e.g. National and Regional Ministries of Health and Education).

SURPLUS: We invest our current income from sales of Peek Vision software and services back into our ‘activities’ (see above) as our primary priority. When we become profitable we plan to use our profits to continue to deliver on our mission of‘ better vision and eye health for all’ by investing back into the sector. The Peek Vision Foundation currently makes small donations in other areas (such as to a scholarship fund at LSHTM to invest in leaders in public eye health across the world).

SEGMENTS: 

1. Beneficiaries: The end beneficiary for Peek are those who are connected to the care they need in a Peek-powered programme. At this stage, we wouldn’t break beneficiaries into any sub-groups. Our software enables our partners to break down their beneficiaries by location/gender/age and other social demographics to analyse which sub-sets are reaching the care they need.
2. Users: We are providing organisations across the world the tools and actionable insights to monitor patients’ journeys to care, address barriers and increase efficiency and equity of programmes. Our vision-testing app is putting eye health directly into the hands of communities across Africa and Asia by enabling non eye health specialists, like teachers or Lady Health Workers, to screen for eye conditions.
3. Customers: Our customers are those which pay Peek for our software and services and are responsible for contracting the implementing partners. Our target market is primarily major eye health INGOs as well as national and regional (e.g. provincial) governments.

REVENUE: Currently 43% Donated income, 57% Sales income, aiming for 30% Donated income, 70% sales income

VALUE PROPOSITION: 

Eye health organisations in low and middle income countries work tirelessly with lean resources. Specialists are in short supply. Conventional screenings are error prone. Programme impact data arrives late. Those with unmet needs remain invisible to health systems.

1. User Value Proposition: Peek Vision’s combination of software and services will enable users to reach more people, connect more people to care, with less cost, greater efficiency, accuracy and equity. Ultimately we will help you make the invisible visible in eye health. We aim to be as user friendly as possible and provide support and training to achieve this.
2. Customer Value Proposition: Peek Vision has a solution that has enabled 16x more people be connected to care at 6.7 less of the cost. We are an end-to-end solution, drawn from a rigorous evidence base

IMPACT MEASURES: 

Programmes: We help our users measure coverage of service, adherence to treatment, and effectiveness of treatment. By addressing barriers and inefficiencies we can help them reach more people, connect more people to care, deliver a better cost per outcome, and increase efficiency and equity.

Organisation/Scale: At the organisational level we will also measure: the overall number of programmes onboarded, facilities connected and people reached (i.e. the scale of our impact in real terms), the % increase of people reaching care, the % of user satisfaction, the % of sales income v donor income and the number of governments backing our solution. 

Our customers are those which pay Peek for our software and services and are responsible for contracting the implementing partners. Our target market is primarily major eye health INGOs as well as national and larger regional governments. 

Our ‘doers’ are implementing partners. These are typically those responsible for delivering eye health services in a given country and consist of eye hospitals and associate health services, regional governments, councils for the blind and more. One programme could have 2-3 implementing partners working together to link up services. 

Our sustainability strategy is to increase our sales revenue as a percentage of our overall income. We will achieve this by increasing the volume of sales. Currently our ‘payers’ are a combination of customers, who pay for our software & services, as well as individual philanthropists, private & public foundations, and grants from government agencies and academic institutions.   

Ideally our main ‘doers’ and ‘payers’ would be National Governments implementing permanent national level eye health programmes which are continually optimised by Peek software and services. We are excited to test and refine this solution over the next three years with our current and potential government partnerships. 

At the global level Peek Vision collaborates with the wider sector to advocate for eye health. We recently celebrated a the United Nations General Assembly (UNGA)’s adoption of the first agreement designed to tackle preventable sight loss. The ‘Vision for Everyone; accelerating action to achieve the Sustainable Development Goals (SDGs)‘ Resolution enshrines eye health as part of the UN SDGs and commits the international community to eye care for the 1.1 billion worldwide people living with preventable sight loss by 2030. 

We are seeing our sector emerge from a focus on specialism to universal relevance, which will drive demand for eye health services, including increased uptake in schools, work places, as part of general health provision and beyond. Technology will play a vital part in helping to meet these demands and increase reach and access to services to those who need them most. 

Governments are becoming increasingly convinced, through the eye health sectors’ advocacy efforts, that eye health is a means by which they can improve their economies and deliver on their SDGs. Peek aims to have the technology ready to help them deliver integrated, equitable, efficient and permanently optimising eye health services.

Peek was born from Andrew Bastawrous PhD’s project, which began back in 2010. The first four years (2010-2014) were taking the idea of this ‘smartphone screening’ and creating the tool and proving it works. The team received significant technical support as well as funding from LSHTM. We continue to collaborate with and apply for joint funding alongside LSHTM, and are currently undertaking a joint research project which is funded by the Wellcome Trust. Peek is also currently developing a new school eye health survey tool (SEHRA), thanks to generous support from USAID. 

The Peek project spun out as an independent organisation from LSHTM in 2015. The next period (2015-2018) was used to apply the Peek approach (our smartphone app and software + live data tracking to uncover blockers), to our own research programmes in Randomised Control Trials. Primary supporters in helping us to develop our initial product and methodology were the Queen Elizabeth Diamond Jubilee Trust and Standard Chartered’s ‘Seeing is Believing Programme’. Our co-founder and CEO Professor Andrew Bastawrous spoke at the 2018 Commonwealth Service, attended by HM the Queen. 

From 2018-2021 we took this proven approach and applied it to live partner programmes. This was a ‘high touch’ period for Peek whilst we finessed the Peek approach in heavy collaboration with our partners, especially our anchor partner CBM. CBM have supported the research and development of our methodology and product, alongside onboarding several ‘Peek powered programmes using our software and services. Other customers include the Ministry of Health Botswana, the Himalayan Cataract Project, African Eye Institute/Cooper Vision/EssilorLuxottica, and Vision Aid Overseas. During this time we have also secured several multi-year 6 figure philanthropic partnerships from private donors and funders.   

We are now (2022-2024) moving into a ‘low touch’ period where we hope to automate much of what we do currently (our core services) into our product, as well as capacitate key partners to perform services the Peek team currently do. We are hoping this will drive more sustainable sales income which will decrease our reliance on grants and donations. 

We also help to leverage funding for our partner organisations. For example, the 17 million euro CBM and Ministry of Health-led Vision Impact Project, covering 10 counties and benefitting more than eight million people was launched in Kenya in 2022. Peek data helped CBM to secure part of this funding for this project from major private donors as well as the German Ministry of Foreign Affairs (BMZ). Together we have had similar successes with regional government support and other support elsewhere.

Peek aims to be adopted by national health systems (primarily in Africa and Asia) where we can deliver a sustainable and value-add business in supporting governments to deliver high-quality, data-driven eye care programmes.  We are working with the wider sector, and especially with our anchor partner CBM, to advocate for and work toward this goal. The upcoming ambitious national programme “Pono Yame” is led by the Ministry of Health Botswana and is the first Peek-powered programme which is set to be fully funded by the government. 

Our current split in funding is 43% sales income and 57% donor income. Our goal by 2025 is to achieve 70% sales income, and ultimately we aim to be fully self-sustaining through sales.