We found several signs of the so-called excessive evaluation anxiety among Rwandan primary healthcare providers, the scope of which should be further investigated. It appears to pose challenges for establishing a supervisory relationship appropriate for generating professional development among providers. A recommendation is for supervisors to adapt a style of communication and behaviour that acknowledges structural evaluation pressures and derived anxiety, and addresses it constructively. This may include the engagement in mutually developed supervisory contracts defining expected and intended roles and functions of all supervision forms and actors. Providers most in need of supervision to improve performance may be most unlikely to benefit from it. Particular efforts to encourage and support providers with performance difficulties are needed, as are structural changes to make the supervision scheme more responsive to providers’ context of challenges at individual facilities.