As part of PBF, external and managerial supervision takes up substantial resources in Rwanda, which should be spent in ways that best help improve practice. We see a need for further studies on supervision, PBF and the problem of excessive evaluation anxiety in the Rwandan context. Questions to explore include how best to identify excessive evaluation anxiety, who are affected and how and the effect of strategies to prevent it. Further research is needed to explore reactions and optimal support of providers who experience multiple mediocre evaluations. Appropriate tools to measure external supervision quality should be locally validated and might serve as specific supervisor feedback. Interventional studies on supervision, PBF, alternative models and excessive evaluation anxiety should be in a controlled design with rigorous methods to quantify single intervention components using validated indicators.3 Finally, it has been suggested that medical doctors with a specialisation in primary healthcare, such as family physicians, play a role in the supervisory support of primary care providers in Africa.29 This could help ensure that supervision effectively addresses providers’ needs for developing their skills in response to the population’s needs for high-quality primary healthcare and should be a topic for further study.