Health Promotion Projects in the field of health services have several challenges in their design and implementation: there is a fundamental tension between proposals based on thebiomedical model and other psychosocial or socio-political approaches. In its implementation, there are aspects of the context that condition its execution and scope beyond the intentions and theoretical-conceptual foundation. Objective: to carry out an implementation analysis of the “Enfamilia-APS Project”of the Universidad de Antioquia´sHealth Insurance Program (Medellin, Colombia). Methodology: single case study. Focus groups, interviews and documentanalysis were carried out considering managerial and operational level and users’ visions. Results:important aspects were identified at three levels of the context. Macro context: the influence of the health insurance model in a market context with the consequent fragmentation of care and deterritorialization in the action of insurers; the conception of risk management with serious limitations for intersectoral action and addressing the determinants of the health of the populations assigned to insurers. At the meso level: the demographic structure of the affiliated population with a tendency to aging, an increase in the prevalence of chronic diseases and the consumption of diagnostic and therapeutic technology and specialized care with the consequent pressure towards increasing spending on clinical care and emphasis on curative instead of preventive and promotive care.Also, the low budget allocation to health promotion and disease prevention programs was identified, including for the “Enfamilia-APS Project”, with the consequent low coverage. The contracting-out through capitation payment reinforces the weakening of health promotion and disease prevention actions, as well as the disarticulation of these activities with curative care. At the micro level, the importance of the health promotion conception adopted in was highlighted, as well as tensions regarding the expectations and the scope of the Project, the influence of the discontinuity in the contracts for its execution, the effect of the budget reduction in the design and scope of the proposal. Conclusion: the health program implementation analysis allows us to understand the influence of the context in its performance. Identifying the aspects that affect the development of a proposal such as “Enfamilia-APS” allows us to realize its limits and possibilities, adjusting expectations to its conditions of possibility.