AIM: To report the development and validation of an assessment approach for competency-based nursing education in low-income settings BACKGROUND: Adopting a competency-based curriculum has been linked with the resource-intensive, programmatic assessment approach. However, implementing this approach in low-income contexts has challenges. Nursing education institutions in low-income contexts reported difficulties implementing programmatic assessment. These challenges threaten the outcomes of the assessment innovation, highlighting the need to develop a tailored approach to assessment for these contexts. DESIGN: A modified e-Delphi study METHODS: The modified e-Delphi was used to refine and validate a proposed assessment approach following the recommendations of Conducting and REporting of DElphi Studies. Nine health professions education experts, with qualifications or publications in educational assessment, or curriculum design and development, were purposively sampled to validate the proposed assessment approach. Consensus was reached at ≥ 70 % after two iterative rounds. Items included in the two rounds were the six domains which described organisational contexts in terms of the people, the culture and technological infrastructure. RESULTS: Eleven out of 47 items in round one did not reach the set ³ 70 % consensus. The 11 items were refined and sent for round two. A total of 46 items were included in the final approach. The results report the developed assessment approach for competency-based nursing education in low-income settings. CONCLUSIONS: A contextually relevant assessment approach should be underpinned by empirical evidence and knowledge of the context. Nursing institutions should support faculty development in assessment to enhance the implementation and sustainability of the assessment approach.