Limited access to Chagas disease diagnosis and trea
tment is a major obstacle to reaching
the 2020 World Health Organization milestones of de
livering care to all infected and ill
patients. Colombia has been identified as a health
system in transition, reporting one of the
highest levels of health insurance coverage in Latin America. We explore if and how this
high level of coverage extends to those with Chagas
disease, a traditionally marginalised
population. Using a mixed methods approach, we cal
culate coverage for screening,
diagnosis and treatment of Chagas. We then identify
supply-side constraints both
quantitatively and qualitatively. A review of off
icial registries of tests and treatments for
Chagas disease delivered between 2008 and 2014 is c
ompared to estimates of infected
people. Using the Flagship Framework, we explore ba
rriers limiting access to care.
Screening coverage is estimated at 1.2% of the popu
lation at risk. Aetiological treatment
with either benznidazol or nifurtimox covered 0.3–0
.4% of the infected population. Barriers to
accessing screening, diagnosis and treatment are id
entified for each of the Flagship
Framework’s five dimensions of interest: financing,
payment, regulation, organisation and
persuasion. The main challenges identified were: a
lack of clarity in terms of financial
responsibilities in a segmented health system, clai
ms of limited resources for undertaking
activities particularly in primary care, non-inclus
ion of confirmatory test(s) in the basic
package of diagnosis and care, poor logistics in th
e distribution and supply chain of
medicines, and lack of awareness of medical personn
el. Very low screening coverage
emerges as a key obstacle hindering access to care
for Chagas disease. Findings suggest
serious shortcomings in this health system for Chag
as disease, despite the success of
universal health insurance scale-up in Colombia. W
hether these shortcomings exist in
relation to other neglected tropical diseases needs
investigating. We identify opportunities
for improvement that can inform additional planned
health reforms.