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.