Abstract Background Cervical cytology is essential for the early detection of cervical cancer. However, in Colombia during 2019, 50% of women with health insurance for poor people (subsidized regime) were screened, compared to 100% of women with health insurance for people with capacity to pay a contribution (contributive regime); these differences reflect significant barriers to face. The objective of this study was to identify the barriers and facilitators of adherence to the cytology exam in low-income women affiliated to the subsidized regime in a public primary care network in the city of Cali, Colombia from 2014 to 2018. Methods In a qualitative case study, the experience of women and health care and administrative personnel was recovered. Forty-seven women participated in seven focus group discussions; Five other women using the program participated in in-depth interviews; Finally, we interviewed eight people from the healthcare area and the health services administration. Results Women describe living conditions, fear, shame, and fears of the procedure as barriers. As facilitators, they recognize agile attention, ease of consulting services, and having social support. However, the health care and administration personnel consider the lack of up-to-date information on women a significant barrier, challenging recruiting and following up. Conclusions complex interventions are required to be adapted to the social conditions, culture, and social processes of the women affiliated with the subsidized health insurance. This might facilitate adherence in groups of non-adherent women with low adherence.