Other relevant forms of managerial power are reward and punishment.13 These are common within managerial supervision systems in sub-Saharan Africa1,2,4,14 and may be determined through performance evaluations.9 Evaluation has been described as the main manifestation of the supervisory power differential15 and is a known source of tension and anxiety.16,17,18 Studies on supervision in psychotherapy practice found strong yet complicated interactions between the practice of performance evaluation and quality of the supervisory relationship.19 Supervisors carrying dual roles of performance evaluator and clinical supporter may find the trust from supervisees threatened if evaluations take place in the absence of basic mutual understanding.20