Early childhood development (ECD) intervention outcomes will be optimal when policies and interventions are multi-sectoral, integrated and responsive to the multiple needs of young children and their families. South Africa’s inaugural 2015 National Integrated Early Childhood Development Policy commits the state to provide publicly available, essential services for young children and their families and foregrounds the needs of vulnerable children. This article tracks progress with policy implementation from an equity perspective. Progress has occurred in sectors that support child survival, while services focused on development from conception to two years are underdeveloped. Targeting services to the most vulnerable children remains inadequate, and the comprehensive systems required to support policy implementation have been deficient. Securing public funding for the delivery of all essential services and prioritizing delivery to vulnerable children are critical to overcoming current challenges. Additionally, strengthening state commitment and leadership of the national ECD programme are necessary systemic elements.