The first five years of a child’s life are a critical and unparalleled period of development, during which an estimated 90 percent of all brain growth occurs. During this period of early childhood development (ECD), children need nurturing care, which includes adequate healthcare and nutrition, stimulation, protection from stress, and opportunities to play and learn. Conversely, if children do not receive the inputs needed to promote healthy development, early deficits can emerge and disadvantage them throughout life. Recognizing the importance of child development, the government of South Africa has made significant progress over the last decade including, the achievement of almost universal access to one year of pre-primary education as well as increasing public funding to support private ECD service providers that serve poor communities. Despite this progress, access to and the quality of services to promote child development during the early years remain a challenge in South Africa, with vulnerable children being at the greatest disadvantage. The main purpose of this Public Expenditure and Institutional Review (PEIR) is to provide options for how to expand and raise the quality of ECD services by increasing and improving public expenditure for areas with the largest expected benefits to individuals as well as the country. The review also identifies how the institutional structures for coordinating, managing, monitoring and delivering ECD services can be strengthened. The ECD PEIR builds on the extensive data and research publicly available in South Africa as well as international evidence, complemented by interviews with key informants engaged in the ECD sector.