In recent years, increasing priority has been placed on the development of national intersectoral early childhood development (ECD) policies in Sub-Saharan Africa. This paper reviews the role of national ECD policies to promote young children’s access to key early childhood services. We discuss the proliferation of national ECD policies in Sub-Saharan Africa in the last decade and argue that for most countries, these documents can be useful, but are not sufficient without proper implementation and enforcement. We look specifically at the different ECD policies and institutional arrangements in four countries in East Africa: Ethiopia, Kenya, Tanzania and Uganda and draw out some cross-country lessons for moving from policy development to implementation.