Aged 70, Tuna has pains in her leg, waist and chest, but her income as a garlic picker put even the most basic medical provision beyond reach. Until her neighbour told her about a “free” medical clinic in the neighbourhood. The cost: 10,000 Indonesian rupiah (£0.59) a month, paid for from cash raised from her recyclable rubbish.
Garbage Clinical Insurance is the brainchild of award-winning healthcare entrepreneur Gamal Albinsaid, CEO of health company Indonesia Medika. In a country where more than 10% live below the poverty line, the scheme encourages low-income households to recycle their rubbish and uses the revenues to finance a health micro-insurance system.
The scheme offers its members access to basic healthcare services in three clinics: two in Albinsaid’s hometown of Malang, East Java, and one near Jakarta. In total, the initiative counts about 600 rubbish-collecting members, who collect on average about 3kg of recyclable materials each per month, which nets them around 11,750IDR (£0.70) from commercial recyclers.
“We have 250 million people in Indonesia but more than 60% of them don’t have any medical insurance … At the same time, a city like mine [Malang] produces over 55,000 tonnes of rubbish every day, only about half of which gets collected,” says 27-year-old Albinsaid.
As well as covering basic medical care, Albinsaid’s initiative has recruited a network of more than 200 volunteers – most of them medical students or recent graduates – who pay members house-calls and advise on preventative care. The company also has a team that works in the neighbourhoods around its clinics to advise people on which recyclable items to collect and then brokers the sale process.
“Previously people tended to think that garbage is worthless and healthcare is expensive, but now they see that garbage can be valuable and healthcare isn’t necessarily so expensive after all,” says Albinsaid, who qualified as a doctor earlier this year.
The innovation has won plaudits, including the Unilever Sustainable Living Young Entrepreneurs Award two years’ ago. Yet it’s not all been plain sailing.
Achieving financial sustainability is a challenge. The business model rests on two key constants: the local price for recyclable materials remaining buoyant, and the number of members visiting the clinics staying at 20% of the total members or fewer. If a higher percentage of members need healthcare each month, the economics of the scheme start to break down.
Administrating the scheme can present problems too. Once a project has taken root in a poor neighbourhood, Indonesia Medika looks to members to manage the waste collection themselves. It’s during this transition stage that schemes often falter, Albinsaid says.
On other occasions, versions of the project have been backed by private companies as a philanthropic measure but then closed abruptly when the sponsor pulled out. Albinsaid wouldn’t be drawn on why these partnerships didn’t work out.
A shortcoming of the Garbage Clinical Insurance model is that it only offers access to the most basic healthcare. The poor access secondary or tertiary health services only if they join the government’s insurance scheme, which starts at around 25,000IDR (£1.49) per month. To make up the shortfall, Albinsaid’s team is now helping its members collect more rubbish and access government funding that they are possibly entitled to but don’t claim.
His final challenge is a more enviable one: satisfying the enormous demand from organisations to copy the model. Albinsaid says he has no desire to franchise his innovation and is happy for others to take it up. Indonesia Medika has put together a 70-page startup manual and the model has spread to more than 50 towns and villages in Indonesia. With limited resources, however, keeping tabs on how, and even where, the scheme is being implemented is proving tricky.
“I have people coming up to me in the airport and saying, ‘Hey Dr Gamal, I have replicated your model’. So you can see it’s hard to manage the replication process, but the benefit is that we inspire a lot of people,” says Albinsaid.
Nicola Dee, a fellow at the Cambridge Institute for Sustainability Leadership and a former mentor to Albinsaid, commends his open-sourced approach to scaling the model. “The upside is that this can create widespread adoption of an idea like this, but the downside is that you don’t really get to know how well the idea is implemented,” she says.
One way of regulating the process would be to introduce a compliance mechanism or certification scheme, but she recognises that this requires resources that most micro-entrepreneurs like Albinsaid lack.
Another hurdle is the need for a robust local recycling market to generate cash revenues from the collected waste. The absence of such a market needn’t be a deal-breaker, Dee says. She cites the example of Plastic Bank, which provides 3D printers to poor communities in developing countries to upcycle plastics collected from the ocean.
Back in Malang, Albinsaid is busy strengthening his management team so they can step into his shoes. “The system is well-established now,” he says, “which is great because it means I can start exploring other new ideas and innovations”.
The Indonesian waste pickers trading trash for healthcare
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