Schwab Foundation Application Form

We strongly encourage all potential candidates to carefully read our selection criteria before completing an application. Please
note that government/public sector personnel, research institutions, and foundations that provide financial or technical support to
social enterprises will not be considered.

This information will be treated confidentially and used only for the purpose of evaluation for the Schwab Foundation
network. If you have completed the Social Reporting Standard (SRS) (or a similarly comprehensive reporting
standard) within the last 12 months, you may submit the SRS in place of this application.

IMPORTANT - The following documents must be submitted along with the application form:
 An updated copy of the applicant’s CV or resume
 Financial statements (income statements and balance sheets) for the last 3 years
 A copy of the most recent annual report
 Any available 3rd party evaluation of your organization
 An organization chart or staffing chart with reporting lines
 Links to videos of recent public talks you have given, or current articles or blogs you may have written
 E-mail addresses of two references. Indicate their name, title, and organization, as well as a brief one-line
description of the nature of your professional relationship (ideally your references can testify directly to your
organization's activities and impact, so a funder, government partner, or third party expert would be ideal).

Information on the Candidate Organization: General

31st May 2014

1. Date of Application (DD/MM/YY):
Garbage Clinical Insurance
2. Social Enterprise Name:
2010
3. Year Established:
Gandaria Street no333, Dieng, Malang, East Java, Indonesia
4. Address of Headquarter Office:
Malang, Indonesia
5. Other Offices (City, Country):
gcicenter.com
6. Website:

7. Legal form of your organization (not-for-profit organization, private company, public company, etc.):
Private Company

8. Sector(s) (i.e. microfinance, health, education, energy):

Microfinance, Health, Environment

9. Geographic area of activity of the Organization

Malang, Yogyakarta, Bandung (all in Indonesia)
 Information on the Candidate Organization: Governance and Management

1. Please describe the functions of your supervisory body (board) and list the members. Are members
compensated? How often does the supervisory body meet?

Supervisory board were dr Rita Rosita from Faculty of Medicine, Brawijaya University, David Darmawan from
Socentix and Nichola Dee from Cambridge University. They get compensation for every published project, we will
mention the supervisory board. The meeting held via direct or online meeting 2 month once

2. Please list your senior management team and their respective positions (i.e. top 3-4 staff).

Gamal Albinsaid as CEO, Makhyan Jibril Al Farabi as chief of Health Applied Science and Technology
Development, Aulia M. Ndoyo as Head of Health Interconnection Deparment, Abdullah Faqih as Head of
Information, Technology and Communication Department and Yesita Rizky as Head of IndoAid Department

3. What is the ratio between the highest paid full-time employee and the lowest paid full-time employee in your
organization? Feel free to provide additional context for this ratio.

The comparison will be 1:4, whereas the lowest income get USD 100 for the part time job, the fulltimer will get
USD 400, but it also depend on the performance, if the fulltimer fail to achieve the goal or KPI, they will get less,
or even only USD 100. Special award will be granted for the employee which showing excellent performance.

4. Who are your top three financial supporters or investors and what percentage of your grants or equity do they
each constitute? If you have owners or shareholders, explain their voting rights.

1. Unilever: from the Young Sustainable Award (80% of fund) they have right to duplicate the project, getting
regular monitoring and evaluation report, giving recommendation for future development, credits for the
publication.
2. Ashoka Foundation (10% of fund) they can give recommendation for future development, credits for the
publication.
3. Kopernik (10% of fund) they can give recommendation for future development, credits for the publication.

Information on the Candidate Organization: Financials

Yes No
1. Are your financial statements audited?

2. What are your main revenue streams and what percentage of your revenues do they each constitute?

Main income are from funding and award, whereas outcome are mostly to develop social program, the 30% of
revenue will be used as asset, whereas 40% for operational and 30% for continuous development of the project.
For the operational cost, 40% are for medical service and garbage processing needs, 50% for wages and fee,
10% are for instrument maintenance.

3. What fees do you charge for your activities, products, and/or services?

For the wage of the employee, we are using Key Performance Indicator based fee, the more staff work, the more
they earn, we give minimally as much as lowest wage permitted by the government (USD 150), and it will
increasing as the work done. For the GCI service, member does need to pay garbage as much as USD 1 per
month and they can get primary health service as much as USD 5
Please provide the following data (financials in either USD or EUR).

Select currency
2015 (estimate) 2014 (estimate) 2013 (actual) 2012 (actual) 2011 (actual)
EUR USD

Earned Income USD 4.000 USD 2.000 USD 1.000

Grants USD 6.000 USD 4.000 USD 3.000
Government Support USD 1.000 - -
Total Revenue USD 8.000 USD 4.600 USD 3.600
Total Costs USD 3.000 USD 1.400 USD 400
Profit (Loss)
Current Assets USD 2.000 USD 1.000 USD 500
Current Liabilities USD 1.500 USD 700 USD 300
Total Assets USD 3.500 USD 1.700 USD 800
Debt USD - USD - USD 500
Equity

Number Direct 10 4 2
Beneficiaries/Clients
Number Indirect 15 8 2
Beneficiaries/Clients
Number Full Time 20 10 5
Paid Employees
Number Volunteers 150 80 40

Information on the Candidate: The Individual

Gamal Albinsaid
1. Applicant (Founder / Chief Executive) Name:
20 hours per week
2. How much of your time do you invest in this organization:
Indonesian
3. Nationality:
08th September 1989
4. Birth Date (DD/MM/YY):

+6281252187266
5. Telephone:

+628179602820
6. Mobile Phone:
gamal.albinsaid@gmail.com
7. E-mail Address:
makhyan.jibril@gmail.com
8. Personal Assistant’s E-mail Address:

9. Languages

Mother Tongue Converse with Fluency Converse with Difficulty Not at all
English

Other:
Other:
Other:
10. Please list the most recent prizes you and/or your organization have been awarded.

1. Young Sustainable Enterpreneur Award 2014 from Prince Charles, Buckingham Palace, UK
2. AusAID Indonesian Prize 2013 Social Innovator Award
3. Promising Award-Winning Social Innovator Award 2013
4. MDG Award winner in 2013 of the President UKP Sanitation Sector
5. Malang Mayor Award in 2014 as Creative Inventor Waste Management

11. What are your motivations for joining the Schwab Foundation network? As a community member, a) How do you
think you would benefit? b) How would you like to contribute to your peers?

I am dreaming for Garbage Clinical Insurance can spread and benefit poor not only in Malang, but all over
Indonesia. Therefore I believe joining Schwab Foundation Network will accelerate these dream. As a community
member, we benefit people toward our project, Garbage Clinical Insurance, which broaden health access and
reduce the unmanaged waste. We benefit the peer toward collaboration project, network sharing, project
replication, idea sharing and business cooperation.

Background: The Social Problem and Your Solution

1. Problem statement

Describe the current social or environmental issue(s) that your organization is trying to solve. Wherever possible,
include detailed information on the target: statistics, figures, and facts. What are traditional responses to this
problem? Why are they falling short?

Indonesia have poor health service for the poor. Although household health insurance population coverage rates
have increased from 15 to 40 percent in 1995-2010, almost 60 percent of the population have no insurance. In
Indonesia, 18 percent of its population continues to live below US$1 a day. Whereas garbage is also big problem
in Indonesia. Yet it holding great potency. For instance, Jakarta, Indonesia, generates 2.77 liters waste per capita
per day. In Malang, people generates 55.000 tons of solid waste each day while 60% of people are open dump
their garbage causing environment damage.

2. Theory of change

We define “theory of change” as the intended social (or environmental) outcome you are trying to bring about and
how your model or intervention achieves those outcomes. What is your theory of change? In other words, “how” is
your model creating change?

Garbage Clinical Micro Insurance is an innovative insurance that using waste as a source of financing. Currently
health allocations at the household level is very low, ie 2.1% of income communities. With this program we try to
do social engineering to change the public perception of the insurance business through rubbish bins. Previous
garbage that is usually burned or dumped, it can be used as a financing health insurance premiums through the
garbage. With this system we change useless society considers (garbage) into something very valuable (health
and nutrition). We have been doing research in the development of this program, to making it easier for the
modification and replication.
 Strategic Collaborators

1. Please describe the nature of any strategic partnerships you have (beyond purely funding relationships). Explain
in concrete, specific terms how each partnership contributes to your organization’s social impact (i.e. companies,
government, international organizations, NGOs, academic institutions, financiers, foundations, etc.).

 Academic Institution (Brawijaya University and Cambridge University):

They support for reference, concept development, research validity and publication
 Philanthropy Organization (LGT Phylanthropy, Ashoka Foundation, Socentix):
They support for concept development, networking toward social enterprise, training and consultation for
the project
 Company (Unilever, Pertamina, Danone)
They support via CSR program and funding,
 Government (Ministry of Health, Ministry of Enviroment, Ministry of Youth and Sport)
They support via award, policy development, government’s organization support

Evaluating your Organization’s Impact

1. In the grid below, share with us evidence of your organization’s current impact and expected future impact. Please
describe in detail the demographics and size of the population(s) you impact and include indicators that you use to
measure impact on each stakeholder segment.

Evidence of Current Impact Expected Future Impact

Direct (on beneficiaries and
clients)
Indirect (on other stakeholders)
 1000 member has been
joined
 3 city joined
 7 clinic join the project
 Member feel benefit from
the clinics
 Each month 2 tons
garbage managed
 Sponsor’s company more
trusted by people
 Healthcare cost reduced by
50.000 per person each
month
 3000 member join
 10 City Join the project
 20 Clinic join the project
 Member feel long term
benefit from the clinic
 Each month 10 tons
garbage managed
 Sponsor’s company more
trusted by more people
 Healthcare cost reduced by
100.000 per person each
month

2. How do you collect this data (tracking sales, anonymous surveys, third party evaluations, etc.)?

1. Direct survey using questionnaire with purposive sampling

2. Direct data gathering at the clinic for GCI member
3. Quantitative research from GCI member with interview

Your Solution at Scale

1. Reflecting on your problem statement, please describe your vision of what your organization’s innovation looks
like at scale.

Indonesia Medika aim to bring innovative project to develop Indonesia’s Health Quality, with Garbage Clinical
Insurance project we dream to make all Indonesian can access better healthcare whilst they also manage their
garbage, In the future we hope everyone in Indonesia can be happily manage their own garbage and get the best
healthcare service. Everyone can contribute to tackle both environment and health problem at once!

2. Please describe your long-term strategic priorities to achieve scale and share your short- to-medium-term
milestones, timelines and expansion plans.

Long term Strategy

 Integrate GCI concept into government led national insurance so that everyone can join the National
Insurance and paying with garbage
 Develop and market GCI replication standard to open more clinic which have GCI service
 Continuous research to ensure the strategy, impact and benefit of GCI project will be more reliable
 Initiate international collaboration to expand GCI to other countries
 Providing best yet affordable and satisfying healthcare service among GCI member
Short term Strategy
 Create GCI role model clinic and standard
 Create GCI replicator team to prepare more GCI clinic all over Indonesia
 GCI promotion toward media and social media
 Seeking for another partner and network to replicate GCI project
 Increase the member of GCI via direct and thorough socialization around GCI clinic
 Monitoring, evaluation and continuous improvement of GCI project

3. What is the biggest barrier to the scale and transformative change you seek?

 The government willingness to implement the policy: as we’ve already plan to Integrate GCI concept into
government led national insurance so that everyone can join the National Insurance and paying with
garbage, at first government say willing to help this goal, but as the times goes by, government are not
showing real act to support or creating real policy for GCI implementation in Indonesia
 GCI concept need some fund to expand the project for the beginning, and it can be sustain after the social
enterprise concept has been established. Therefore, we need some funding to expand GCI service in
other place
 People are less believe that GCI concept is possible and exist. At first, mostly they will not believe it and
hesitate to join GCI program. They think the program will force them to do something (e.g vote for specific
party, paying the fee as a loan, etc). Therefore, we need thorough socialization, more proof and more
media publication to attract people to be GCI member

4. What external factors (i.e. social trends, policy changes, new technologies) might affect your organizational
strategy? How are you factoring these risks and opportunities into your strategy?
 Social trends: people nowadays want pragmatic instant service, especially for the poor people, they will
think that if they don’t get sick, then they do not need to pay the garbage fees. To tackle this problem, we
provide prevention and health promotion program that can benefit all the member even they’re not getting
sick
 Policy changes: in 2013 there is no national insurance for all of Indonesian citizen, 60% of them are not
having insurance. But in 2014, government plan to cover national insurance for all of Indonesian citizen
which target 2019 everyone will join the insurance. Therefore, to prevent insurance overlap, we plan to
integrate GCI with national insurance system
 Partner Relationship: in 2014, GCI partner for garbage processing, BSM (Bank Sampah Malang: Malang
Waste Bank) withdraw the collaboration contract with GCI. BSM feel they’re more superior as they’re the
one who process the garbage yet they are not getting the award from government, prince Charles etc. to
tackle this program we create a win-win solution for the next collaboration that is to give the award or
media publication opportuinity for our garbage processing partner