Early childhood care and development (ECCD) services have been steadily expanding with structures on the community, national, and international levels. However, many low- and middle-income countries still have very limited ECCD coverage, and there is a lack of global guidance on best practices for effectively expanding pre-primary education. In 2015, Bhutan completed a national evaluation of existing ECCD programmes in the country in order to begin an evidence-based way forward with this process. The study used the international development and early learning assessment to evaluate programme impact on children’s learning and development. Results find that children with access to centre-based programmes gain more skills than children without access to these programmes. Analyses also display that higher quality centres and those with fewer children are associated with stronger child learning gains. Finally, family wealth and positive home care and learning environments are significantly positively related to learning.