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Objective: To compare a multidimensional care package for pre-eclampsia/eclampsia in Central American health facilities, before and after implementation of the Salud Mesoamérica Initiative., Methods: An evaluation study was conducted at 67 basic- and comprehensive-level health facilities serving the poorest areas in Honduras, Nicaragua, and Belize. Cases of severe pre-eclampsia or eclampsia were randomly sampled and relevant quality of care data extracted from medical records at baseline (n=111) from January 1, 2011, to March 31, 2013, and at second-phase follow-up (n=249) from June 1, 2015, to September 30, 2017. The primary outcome was evidence of the delivery of multidimensional care for the management of pre-eclampsia/eclampsia., Results: The care of 360 women with severe pre-eclampsia or eclampsia was analyzed. Odds of multidimensional care for pre-eclampsia management (P=0.271) increased (although not significantly) in the second-phase follow-up compared to baseline. Multidimensional care was significantly associated with training (P<0.001), basic-level facilities (P<0.001), and higher in Honduras (P=0.001) and Belize (P=0.024) than the reference country of Nicaragua., Conclusion: Multidimensional care for pre-eclampsia management increased across all facility types, countries, and severity of disease. The Salud Mesoamérica Initiative is a promising model for achieving such quality of care interventions in the era of universal health coverage., (© 2020 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)