Understanding access to healthcare is relevant to assess the efficiency of healthcare services and to identify inequalities. Access to healthcare represents the outcome of a complex phenomenon that involves the structural characteristics of the healthcare system and multiple processes for providing services. Measuring access to healthcare requires the consideration of various outcomes while understanding the interrelationship between the characteristics of the healthcare system. Analysing the interrelation between the attributes of the health system and the outcomes frequently is frequently overlooked, its measurement represents a significant challenge in many countries. This thesis provides a unique contribution to the literature by exploring access to healthcare services using a health system perspective in a Global South country. The research studied the interrelation between access to healthcare and structural factors of public service provision. The analysis measures access to healthcare for users of public healthcare facilities to identify who benefits from services provided at two levels of the healthcare organisation. Guatemala represents a suitable scenario to explore access to healthcare, with a public healthcare system that is comparable to many Global South countries. Access to diverse and comprehensive healthcare services is essential for the wellbeing and social development of the population in Guatemala. The findings indicate fundamental inequalities in access, with certain demographic groups and rural areas facing significant barriers. This research provides empirical evidence that access to public healthcare services in Guatemala is highly influenced by the structural characteristics of the service provision.