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Background. A competency-based curriculum was adopted for a 1-year post-basic midwifery programme in a small African country with a high maternal and neonatal mortality ratio. Two years after nation-wide implementation, disparities in the enactment of the curriculum were observed within and across the nursing education institutions (NEIs). Such disparities were attributed to lack of a framework in implementing the new curriculum, which jeopardised sustainability of the entire competency-based midwifery programme. A framework for implementing and sustaining a curricular innovation in a higher education midwifery programme was developed. Objective. To develop and validate a framework for implementing and sustaining a curricular innovation in a higher education midwifery programme. Methods. A multiple-methods research design was used to develop the framework, guided by the theory-of-change logic model. This design was executed in three sequential but interrelated phases, inclusive of an integrative review, a gap analysis of the implementation of the programme and a framework-development process. Primary implementers from all NEIs in the setting validated the developed framework through discussion and consensus. Results. A framework for implementing and sustaining a curricular innovation in a midwifery programme was developed. It reflects an integration of evidence obtained from research and expertise from primary implementers of the curriculum. Conclusions. Designing a strategy for higher education institutions (HEIs) for implementing and sustaining curricular innovations should be based on an interplay of empirical evidence and contextual realities. HEIs should identify challenges related to curriculum implementation, and recommend tailor-made approaches that are based on evidence. Primary implementers of the curriculum are fundamental in enhancing the validity and feasibility of such a strategy within their setting.