This International Monetary Fund paper highlights the macroeconomic relevance of SME financial inclusion in the MENAP and CCA regions and offers policy considerations to scale up SME financial access. "Financial Inclusion of Small and Medium-Sized Enterprises in the Middle East and Central Asia" focus is primarily on the macroeconomic and policy aspects of SME financial inclusion, and not all issues relevant to SME financing are covered. It is organized as follows: the first section presents the SME financial inclusion gap in the MENAP and CCA regions and potential macro-financial benefits from reducing this gap. The next section builds on empirical analyses to identify key drivers of SME access to financing, especially in MENAP and CCA countries. Reviews of the role of alternative channels of SME financing, such as capital markets and fintech, follow, building on international experience. The final section takes stock of existing efforts to support SME financial inclusion and suggests policy approaches that are both holistic and tailored the specific needs of MENAP and CCA countries.