SummaryBackgroundSkilled facilitators are essential to drive effective simulation training in healthcare. Competency‐based frameworks support the development of facilitation skills but, to our knowledge, there are no frameworks that specifically address context‐sensitive priorities developed with practitioners working in low‐resource settings.MethodsWe aimed to develop a core competency framework for healthcare simulation facilitation in low‐resource settings using a modified Delphi process. We drew on the domain expertise of members of the Vital Anaesthesia Simulation Training Community of Practice, with the study guided by a four‐member steering group experienced in the conduct of simulation in low‐resource settings. In survey round 1, participants (n = 54) were presented with an initial competency set derived from a previous qualitative study and co‐created a set of 57 competencies for effective simulation facilitation in low‐resource settings. In survey round 2, participants (n = 52) ranked competencies by relevance into three performance categories: techniques; artistry; and values. In survey round 3, participants (n = 50) ranked competencies on their importance. The steering group collated results and presented a draft core competency framework. In survey round 4, participants (n = 50) voted with 98% agreement that this framework represented the most relevant and important competencies for effective facilitation of simulation sessions in low‐resource settings.ResultsThe final 32‐item framework encompasses core competencies found in existing standards and includes important new concepts such as demonstration of cultural sensitivity; humility; ability to recognise and respond to potential language barriers; facilitation team collaboration; awareness of logistics; and contingency planning.DiscussionThis competency‐based framework highlights specific practices required for effective simulation facilitation in low‐resource settings. Further work is required to refine and validate this tool to train simulation facilitators to deliver effective training to improve patient safety.