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Formative supervision is a quality and performance tool based on evaluation and adult training techniques. The 2004 cholera outbreak in Douala (Cameroon) presented a critical problem in terms of quality of care; formative supervision emerged as the choice of instrument developed as a key response and solution. After a chronological qualitative description of how the supervision team and system were constituted, established and organized, the results are presented: strengthening infrastructure, equipment and organisation; improving the quality of care, hygiene, communication, and management. The system requires capacity building for sustainability in order to also be eventually extended to other health districts and other health sector activities, on the condition that the necessary resources can be mobilized.