PURPOSE:
The framework supports development of country investment cases for scaling up or establishing care provided by midwives at country level. The primary audience includes health planners and policymakers aiming to build a compelling case for investing in midwifery models of care (MMoC), which can improve maternal and neonatal health, efficiently utilize healthcare resources, and yield economic gains. The framework is a tool for analying and articulating the benefits of investing in care provided by midwives, and it provides methods to estimate the impacts, economic costs benefits, and investment requirements for scaling up or establishing care provided by midwives within a country context. This presentation will report findings from applying the framework in three countries: Zambia, Sierra Leone, and Egypt. We will examine the findings from each country, highlighting the economic benefits associated with expanded care provided by midwives, and further discuss policy implications for transition to MMoC.

DISCUSSION:
The framework outlines seven steps to build an investment case for MMoC. These steps include situation analysis, defining the care package, estimating health impacts and costs, workforce development, and calculating benefits and return on investment. The framework also highlights the importance of an enabling environment for midwives, alongside robust monitoring and evaluation systems, to ensure sustainable investment. While acknowledging limitations in modeling the full scope of midwifery practice, the framework focuses on quantifiable impacts such as lives saved, morbidity reduced, and unintended pregnancies averted.

EVIDENCE WHERE RELEVANT:
Midwives, when fully integrated into health systems, can deliver approximately 90% of essential sexual, reproductive, maternal, newborn, child, and adolescent health interventions, offering a cost-effective solution to improve outcomes and strengthen health systems. This presentation fills critical country-specific evidence gaps, particularly in low and middle-income settings.

KEY MESSAGE:
Strategic investment in MMoC is essential for improving health outcomes and advancing socioeconomic development while realizing significant economic benefits. Continuity of care - implementation 1