Universal Health Coverage and Health Facility Delivery in Indonesia: Case Study of Revolusi KIA Program Salut Muhidin 1 , Rachmalina Prasodjo, Maria Silalahi and Jerico F. Pardosi (Contact: salut.muhidin@mq.edu.au) 1) Macquarie University, NSW Australia Draft Presentation at the Population Association of America 2016 Annual Meeting Program Washington DC, March 31st – April 2nd 2016 Abstract. Indonesia has proposed a National Social Health Insurance Scheme (or JKN-Jaminan Kesehatan Nasional) since 2005. It aims to have every Indonesian, especially to the poor families, covered by health insurance which includes for giving births at health facilities. Since 2009, NTT (Nusa Tenggara Timur) province implemented Revolusi KIA, a program to encourage health facility delivery. Yet, participation in this program in some areas remains suboptimal. This paper evaluates the implementation of this program among users (mother, fathers & community) and implementers (health providers) to better understand barriers and enablers to facility delivery with special attention on the optimal use of health insurance. The study found that health insurance indeed affect the performance of this program. In addition, the promotion efforts endorsed by village leaders and fathers, greater publicity around insurance schemes, and increasing availability and capacity of midwives may contribute to greater facility deliveries in this rural province. 1. Introduction In the context of developing countries, health facility-based birth has been considered as one of the important strategies in reducing maternal and child mortality (Murray & Pearson, 2006). Nevertheless, several studies have shown that many women in both low- and middle- income countries are still having difficulty to access health facility for delivery purposes (Bohren et al, 2014; Finlayson & Downe, 2013; Campbell & Graham, 2006; WHO, 2007; Kerber et al, 2007). Far distances, financial-related costs including limited access of health insurance, poor quality of services, health personnel unavailability and lack of transportation in reaching the closest health facility are major reasons of why rural women prefer to deliver at home than health facility (Cham et al, 2005; Sharma et al, 2007; Pardosi et al, 2014; Manithip et al, 2013). As a result, these conditions could lead to either maternal or early-age deaths, especially for those in rural areas (Shrestha et al, 2012; Jones et al, 2003). A cross-national study done by Montagu and his colleagues (2011) using 23 DHS countries data confirms previous research findings that most poor women in the developing world (e.g. about 8 to 9 out of every 10 women in Sub- Saharan Africa, South Asia, and Southeast Asia regions) are reported to give births at home. Revolusi KIA Program in NTT Province Similarly in Indonesia, the program of health facility-based birth through Safe Motherhood initiatives has been promoted, especially in the regions where mortality rates are still high. The NTT province in Indonesia has traditionally faced high rates of maternal and child mortality for several decades. Based on the 2012 Indonesia DHS Report, maternal mortality rates (MMR) and the infant mortality rates (IMR) in this province were at the high levels of 307 deaths per 100,000 live births and 57 deaths per 1,000 live births, respectively. A higher proportion of childbirths occurred at home with higher risks of blood loss (hemorrhage) and other complications during deliveries leading to higher maternal and neonatal deaths. The lack of adequate health care facilities at the village level has been claimed as the main issue. Moreover, access to health services among disadvantaged and remote communities