This study provides an updated look at Medium-Term Expenditure Frameworks (MTEFs). As the world is emerging from the COVID-19 pandemic, this study suggests that MTEFs responded to the dislocations of the pandemic and emerged intact. It reinforces the view of an earlier World Bank study (2013) that MTEFs, when well-designed and implemented meaningfully, can contribute to improved public policy and financial management. The analysis in this report draws on two diverse sources of information-a survey and case studies. This report aims to provide an updated view on the evolution and performance of MTEFs. The report highlights the results of a World Bank survey of on details of MTEF implementation and includes case studies on MTEF design, implementation, and performance in eleven countries. The survey results and case studies provide insight into how MTEFs are developing in the countries that implemented them over the past few decades and how MTEFs are helping countries to address key issues, including improving the efficiency of fiscal policies and spurring further reforms in the management of public finances. Both the survey responses and the case studies cover a range of countries, from various regions and at different levels of development.