Garbage Clinical Insurance

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Garbage Clinical Insurance : Micro Health Insurance Which Use Garbage as Financial Resources

malang, IndonésieMalang, Indonésie
Year Founded:
Organization type: 
Project Stage:
$50,000 - $100,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

Garbage Clinical Insurance (GCI) is a micro health insurance program which uses garbage as a financial resource. The community pays clinical services by using garbage in an insurance scheme. We open doors to health access because health is fundamental human right.

WHAT IF - Inspiration: Write one sentence that describes a way that your project dares to ask, "WHAT IF?"

What if garbage can finance the poor's health access?
About Project

Problem: What problem is this project trying to address?

Indonesia is classified by the World Bank as a middle-income country. We have 250 million people, but more than 60% of the population still remains without any coverage. Recent estimates indicate that about 18% of its population continues to live below US$ 1 a day, and about half lives below US$ 2 a day. Households spend about 2.1% of their total consumption on health, Many people can not get access to health care due to financial factors.

Solution: What is the proposed solution? Please be specific!

This motivates us to develop garbage insurance scheme as health financing that we call Garbage Clinical Insurance. Garbage Clinical Insurance (GCI) is a micro health insurance program which uses garbage as a financial resource. This can make the community mobilize their own unused resources to improve health access and break down barriers between health facilities and community members. We take an active role in managing health financing and promote health investments for poor with garbage. Practically, in general, residents must pay fee to government to dispose of their garbage, but we offer residents to submit their garbage worth US$ to us. It is then is used to cover their health care in a holistic manner.


HRH The Prince of Wales Young Sustainability Entrepreneur Award
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

Garbage Clinical Insurance (GCI) is a health insurance program which uses garbage as financing tool. With this program, community give their garbage to the clinic regularly. Afterward, collected garbage is processed in two ways, organic waste is processed to be fertilizer by applying Takakura composting method and Inorganic waste, such as paper, cans, bottles, plastic, is sold to collectors. Each month the collected garbage reached about 10.000 IDR, which is used to cover health care in a holistic manner, covering the patient's treatment(curative), making health care quality improvement programs (promotive), preventing illness(preventive), and rehabilitative aspects, such as free treatment, inclinic counseling. laboratory check, etc.

Impact: What is the impact of the work to date? Also describe the projected future impact for the coming years.

The program has been replicated in a lot of cities in Indonesia. I work with 45 youth people aged 18-26. Garbage Clinical Insurance aim to replicating its program in other places to enhance and spread its usefulness in broader zones. Today, I have support replications in other region, such as 17 government agency, 21 University, 18 NGO and company. But this is not enough for me. Frankly, I am not satisfied yet with what I did. My goal is not only create breakthrough program, but also how to make it more effective and efficient. Through those program, he hope to accomplish problem in my own country and Indonesia could possess better human resources quality. Every Garbage Clinical Insurance has achieved approximately 200-700 members with membership cards system. We start 2010, empower 157 youth people to take an active role and we support more than 2000 people to get health access.

Spread Strategies: Moving forward, what are the main strategies for scaling impact?

Massive Replication : a. Creation of new programs in other regions (Initiation), b.Ensure power of sustainability (Stabilization), c.Society self-reliance (Independence). Following the previous award and publication, we had been approached by various parties (government, NGO, as well as private) to replicate the model. But organizing the community takes process.

Financial Sustainability Plan: What is this solution’s plan to ensure financial sustainability?

The revenue stream of this model is garbage collection, profit margins from the insurance scheme, garbage processing. With this program, community gives their garbage to the clinic regularly. Afterward, garbage is processed into health fund. First of all, inorganic waste, such as paper, cans, bottles, plastic, is reused and recycled. Secondly, organic waste is processed to be liquid and solid fertilizer by applying composting method.

Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?

There are a number of groups with waste collection initiatives and insurance scheme. However, we are the only focused effort to combine both approaches - managing waste into micro insurance and health service. Our distinctive characteristics are: 1) using garbage as a source of financing, 2) applying holistic health system,namely promotion,prevention,curative,rehabilitative. 3) socialentrepreneurship and social engineering,, 4) broad access, because all citizen can join this program, 5) community independent financing, 6) increase value garbage exponentially, 7) manage sanitation improvement.

Founding Story

I believe that health is a fundamental human right. Hovewer, in reality many people cannot get health access because they do not have sufficient money and the cost for medication is expensive. Indonesia has a huge problem regarding access to healthcare. For example, the true story of a 3-year-old girl, Khaerunissa, that happened June 5, 2005. She was the daughter of a 38-year-old scavenger, Supriyono, who only earned 10,000 every day. She got diarrhea, but she could not get access to health services due to unaffordable health cost. Finally,she died because of diarrhea. In responding to this heart-breaking social phenomenon, then we started to think how we could create health financing model.


I am working with a creative, passionate, and dynamic 45-member team of educated and experienced individuals. We come from wide range of disciplines. In local management structure, we divide our management team into 3 divisions, namely : 1. Financing Division, Financing Division is responsible for managing garbage as a financing resource and responsible for developing sustainability in terms of financial aspects 2. Service Division, Service Division is responsible for streamlining health services and developing public health in the community, 3. Research and Development Division Research and Development division is responsible for collecting and analyzing data in order to monitor, improve, and modify the quality of the program. FUNCTIONAL TEAM FOR MASSIVE REPLICATION GARBAGE CLINICAL INSURANCE 1. Replicator Team, a. Conduct training for project managers, project officers, and team support, b. Communication with stakeholders, c. Accountability on the Expert Team and Stakeholders d. Intensive supervision program, e. Data analysis in the implementation of the program, f. Ensure stakeholder satisfaction in cooperation, 2. Expert Team, b. Conduct systematic and progressive research and development of program in order to monitor the overall Garbage Clinical Insurance program in an effort toward duplication and modification, in both the financing and service systems. c. Able to become a place to exercise their functions in the administration of academic and scientific programs Advisory Board : Dr. Rita Roshita, M.Kes [lecturer at Brawijaya university], Eveline, [Ashoka Changemakers Network Coordinator South East Asia & Pacific, Ashoka Indonesia], R. Sudirman, [4th Deputy Assistant Waste Management ministry of Environmental and Forest], Drs. H. Sakhyan Asmara, MSP, [2nd Deputy Ministry of Youth and Sports Republic of Indonesia], Nichola Dee, [Lecturer at Cambridge Program Sustainability Leaderhsip, Cambridge University], Emma Mee, [Lecturer at Cambridge Program Sustainability Leaderhsip, Cambridge University], David Darmawan, [CEO PT. Socentix], David Soukhasing, [Investment Manager, Southeast Asia at LGT Venture Philanthropy], .
CO-CREATION IDEA: Please offer a brief description of how you imagine a win-win partnership with Boehringer Ingelheim to better serve unmet needs in health. (Hint: Please mention the underlying business model envisioned that would make such a partnership sustainable.)

1.Massive replication
Boehringer Ingelheim has enormous power to accelerate enlargement of this program. In the next step we hope to perform a systematic and organized effort to gain the support of your resources, such as networking support, idea support, and policy support. Boehringer Ingelheim can help us creation of new programs in other regions, ensure power of sustainability, society Independencing.

2. Education, Training, and Research activity for Role Model Development
In developing this product, we need science aspect (scientific) and research in order to make the referral program as a role model or a reliable micro-insurance. Research with Boehringer Ingelheim is one way to build confidence (trust) and external credibility.

NEEDS: Based on you response above, please specify which of the following resources, operations or expertise by Boehringer Ingelheim you imagine leveraging to actualize the proposed co-creation opportunity. Please check all that apply. (Hint: while financing is often critical to scale, we are also interested in understanding what other assets or expertise could be leveraged).

Distribution Channels, Research and Development, Marketing/Communications Support, Legal Support, Public Policy Knowledge.

EXPLANATION OF NEEDS: Please explain your choices in more detail.

As a pilot project, Garbage Clinical Insurance should implement the results of analysis, research, and development of a holistic and integrated manner. The analysis includes the analysis of health services, financing programs, and quality control. Moreover, as the pilot projects, Garbage Clinical Insurance expected to conduct interdisciplinary approaches in the development of this program, including health, environment, community psychology, community communication, community economics, program administration, and others. Then, Garbage Clinical Insurance need modification in the future.

OFFER: What are the main assets you may contribute in a co-creation partnership with Boehringer Ingelheim that would better serve unmet needs in health?

Insights into distribution.

FOCUS AREAS: Which of the following best describes the main focus of your project? (select all that apply)

Improving the affordability of healthcare (e.g., microinsurance, reducing the economic cost of care).

Please share what your organisation and Boehringer Ingelheim will Co-Create together

Garbage Clinical Insurance (GCI) is a micro health insurance program which uses garbage to pay insurance scheme. The community mobilize their unused resources to finance fully operating healthcare service, thus improving health access and environmental condition (reducing waste burning/ littering).
With Boehringer Ingelheim (BI), we hope to replicate GCI globally. With this model, BI can provide affordable health service through community-based healthcare facility, and improve local sanitation through community-based waste management (thus making more health). This model ensure sustainability and cost-effectiveness, in comparison to building a charity-based conventional clinic. Business wise, this opens new distribution channel for BI products to low income market.

Please specify what your Co-Creation will result in:

a new service, a new distribution channel, a new market/customer group.

If you selected "other" above, please explain:
Please provide a 1-2 sentence summary of your Co-Creation idea

Boehringer Ingelheim (BI) & Garbage Clinical Insurance (GCI) micro health insurance program - a sustainable community based healthcare plus sanitation solution. Together, we open doors to health access for all and promote a new approach to sanitation problem through the use of garbage as investment tool for health.

How does this project link to the core mission of your organisation?

Our mission is to open doors to health access for all, by providing affordable health service using garbage as investment tool. We believe health is fundamental human right. The main focus of Garbage Clinical Insurance is to provide/ finance independent and sustainable health service maintained by community organization. Garbage Clinical Insurance (GCI) is a prototype of micro health insurance system which is easy to replicate in areas with limited access to healthcare service .

Beyond social impact, how does this project link to Boehringer Ingelheim’s core business?

Potential link:
- expanding BI pharmaceuticals market: the micro insurance scheme may also cover pharmaceuticals associated with the condition treated.
- creating new distribution for BI pharmaceuticals: the healthcare service (clinic) may include drug kiosks unit serving BOP market.
- research and development opportunity: the BOP market is prone to various diseases due to personal (e.g. lack of knowledge to support healthy behavior) and environmental (e.g. pollution, poor sanitation) factor. This would be an ideal subject for research on various diseases.

What are the specific inputs and actions that each side will contribute to this Co-Creation idea based on each of your unique competencies and experiences?

My organization will contribute expertise for project implementation. We have over 6 years of experience of developing Garbage Clinical Insurance from research activity to 6 trial sites in different local condition. We have our team of competent implementer and some potential partner, such as Ministry of Environmental and Forestry Ministry, Health Ministry, Cambridge University, and strategic NGO. We have also open source materials that can be adopted by BI.

Boehringer Ingelheim will contribute support for project replication (monetary/ in kind/ human resources), within BI global network. We also hope to improve GCI with support from BI expertise in business analysis, marketing, legal issue, partnership, and research & development.

Please describe the potential revenue model for this Co-Creation idea.

The main revenue comes from waste management: sales of recyclables/ up-cycling products and compost (from processed organic waste). Other potential revenue are service cost paid by non-member patients, and small fee for waste processing (lower than the cost of neighborhood waste service fee).

What possible risks or challenges do you foresee?

- Local community engagement: the community willingness to participate
- Local waste infrastructure: existing facilities in place
- Recyclables price instability: ability to secure a good price for waste
- Managing organic waste: composting requires investment upfront and careful management
- Local government engagement: collaboration with existing two key services - healthcare and waste management
- Widespread epidemic: should a significant health crisis (e.g. Ebola) affect a community implementing GCI model, health clinics could be overwhelmed.

Is there anything else you would like to share about your Co-Creation idea?

We believe this idea in line with Boehringer Ingelheim "Value through innovation", in which value is Trust, Passion, Empathy, Respect.
Garbage Clinical Insurance is born from empathy on people without healthcare access and passion of improving healthcare. In the idea and implementation, we respect the poor by trusting their capability to create sustainable financing from their own resources, and facilitate people to improve the access and quality of health service from promotive, preventive, curative and rehabilitative aspects.

How much input do you hope to receive from Boehringer Ingelheim?

I’d like to implement together, I mostly need strategic advice, other (Please explain below).

If you selected "other" above, please explain:

Also interested in in-kind support (e.g. pharmaceutical supply) and potential research activities.

Besides Boehringer Ingelheim, what other types of partners might be valuable to carrying out your Co-Creation idea, and why?

Government, particularly:
- Ministry of Environment: Through Ir. Sudirman, our contact, we plan to include garbage clinical insurance as a prerequisite of Adipura Award. This gives opportunity for us to spread the idea and give training more than 20 local government in province and city level.
- Ministry of Health: Indonesia recently develop National Health Security program. This program become new opportunity to spread the idea of Garbage Clinical Insurance. We try to integrate premium system with JKN, here our options: 1), we offer residents to submit garbage as worth 25.000 IDR, 2) residents pay 15.000 IDR, 3) adopt form of PSO.