The restrictive power of rewards is inherent to PBF. Applying promotive sources of power by engaging in non-judgemental interaction with providers to understand their needs and problems at work seems necessary to facilitate meaningful collaboration and sustainable improvements in practice.21 One approach would be to engage providers and supervisors in developing a supervisory contract to clarify roles, expectations and intentions.16,18 A supervisory contract should include ethical aspects concerning the supervisory relationship with reference to confidentiality, providers’ fear and welfare as well as proper communication.18 This may also address gender equality in the supervisory relationship because the majority of primary healthcare providers are female as opposed to the majority of supervisors being male, and also because female providers in one FGD shared experiences of supervisors using gender discriminating terms (such as saying ‘those women’ in a derogatory way). In the mixed FGD, male supervisors agreed that such terms were unacceptable. This together with the fact that other FGDs did not raise the issue of gender discrimination may indicate that such discrimination is the exception rather than the rule.