•Quality improvement (QI) programs are warranted in sub-Saharan African countries owing to the existing substandard quality of care currently being associated with poor maternal and neonatal health outcomes.•Knowledge on costs and cost drivers for this and similar future Quality Improvement (QI) programs can inform implementation planning, budgeting, resource requirements and resource mobilization approaches both for scale-up and sustainability.•Implementation of evidence-based midwifery quality improvement (QI) practices (DBP, SSC, DCC practices) under the MIDWIZE framework is clinically feasible at reasonable economic and financial costs for a health facility (based on scenario 1 and 2 of implementation) in resource-constrained settings using the collaborative program implementation approaches.•From a programmatic scenario approach (scenario 3) that assumes that the health facility does not have donor funding, higher financial and economic costs to achieve similar adoption levels for the QI practices (DBP, SSC, DCC practices adoption levels in collaborative approaches) are required to be mobilized by the health facility through expanded budgetary allocation support as well as from alternative facility financing and resource mobilization strategies.•Reproductive health leaders, health facility managers and policy makers can use this information on scenarios of costs and resource requirements to project, plan, and budget for scaling the QI implementation in similar settings and in covering major costs drivers’ especially financial and economic costs for the capacity building for a QI leader. Three evidence-based midwife-led care practices: dynamic birth positions (DBP), immediate skin-to-skin contact (SSC) with zero separation between mother and newborn, and delayed cord clamping (DCC), were implemented in four sub-Saharan African countries after an internet-based capacity building program for midwifery leadership in quality improvement (QI). Knowledge on costs of this QI initiative can inform resource mobilization for scale up and sustainability. We estimated the costs and intermediate outcomes from the implementation of the three evidence-based practices under the midwife-led care (MIDWIZE) framework in a single facility in Kenya through a pre- and post-test implementation design. Daily observations for the level of practice on DBP, SSC and DCC was done at baseline for 1 week and continued during the 11 weeks of the training intervention. Three cost scenarios from the health facility perspective included: scenario 1; staff participation time costs ($515 USD), scenario 2; staff participation time costs plus hired trainer time costs, training material and logistical costs ($1318 USD) and scenario 3; staff participation time costs plus total program costs for the head trainer as the QI leader from the capacity building midwifery program ($8548 USD). At baseline, the level of DBP and SSC practices per the guidelines was at 0 % while that of DCC was at 80 %. After 11 weeks, we observed an adoption of DBP practice of 36 % (N = 111 births), SSC practice of 79 % (N = 241 births), and no change in DCC practice. Major cost driver(s) were midwives’ participation time costs (56 %) for scenario 1 (collaborative), trainers’ material and logistic costs (55 %) in scenario 2(collaborative) and capacity building program costs for the trainer (QI lead) (94 %) in scenario 3 (programmatic). Costs per intermediate outcome were $2.3 USD per birth and $0.5 USD per birth adopting DBP and SSC respectively in Scenario 1; $6.0 USD per birth adopting DBP and $1.4 USD per birth adopting SSC in Scenario 2; $38.5 USD per birth adopting DBP and $8.8 USD per birth adopting SSC in scenario 3. The average hourly wage of the facility midwife was $4.7 USD. Improving adoption of DBP and SSC practices can be done at reasonable facility costs under a collaborative MIDWIZE QI approach. In a programmatic approach, higher facility costs would be needed. This can inform resource mobilization for future QI in similar resource-constrained settings.