This paper describes a program in Côte d'Ivoire designed to assess and enhance the competence of primary health care providers using clinical vignettes. The initiative provided training to district supervisors in 113 health districts on how to present patient scenarios to providers to assess their skills in history taking, physical exam, diagnosis, treatment and provision of patient advice. The clinical vignettes covered common topics in maternal and child health and infectious diseases. Several technical improvements were applied, including improved organization and clarity of questions, flexibility in treatment choices, options for management for rural areas and clearer standards for what information should be communicated to patients. The program also aimed to enhance content validity by mapping vignette questions against national practice guidelines. A training manual with role-playing exercises was developed. Supervisors conducted an initial sample of vignettes which revealed that only 36 percent of providers achieved a satisfactory score. The Project ECHO virtual learning platform was then used to address implementation challenges among district supervisors, who shared ideas for improvement. Learning sessions with midwives focused on managing preeclampsia. An electronic tablet tool was also designed for assessments, allowing data transfer to the national health information system, and key design features included offline assessment capability. The paper provides a comprehensive account of program design, challenges, and solutions, so that other countries interested in developing similar programs can learn from this experience.