BackgroundThe South African government has introduced Performance Management and Development System (PMDS) as a tool to monitor and manage the performances of health institutions, in order to improve service delivery within primary health care settings. The aim of the study was to determine the knowledge and practices of supervisors regarding PMDS in primary health institutions of the Limpopo Province.Materials and MethodsA cross-sectional, descriptive, quantitative study was used. A total of 117 participants were sampled using stratified random sampling technique and a questionnaire was used to collect data. Statistical Package for Social Sciences (SPSS) version 22.0 was used to analyse both descriptive and inferential statistics.ResultsGenerally all the respondents had an average (65.8%) understanding of the PMDS processes including the purpose and their roles as supervisors. However, a gap exists between the theoretical knowledge and the actual ability to practise PMDS which was found to be at 52%. There are areas of weakness that still need attention, such as unavailability of PMDS guidelines and lack of training of both supervisors and employees on PMDS.ConclusionThis study highlights the problem of lack of knowledge and skills, unavailability of PMDS policy and poor induction into PMDS. To improve the knowledge and ability to supervise PMDS, proper induction of all PMDS supervisors and periodic in-service training should be done; reference materials, the PMDS policy manuals, are to be made available in the facility and all supervisors be orientated on how to use these manuals.