Background: The value of Early Childhood Care and Education (ECCE) is recognised as beneficial to the child and society. Research evidence on pre-primary ECCE access and quality in Sub-Saharan Africa is scarce. Aim: The aim of this article is to examine Botswana's pre-primary school programme in enhancing accessibility and quality of ECCE provision. Setting: The study was conducted in 12 of the 24 primary schools implementing the pre-primary programme in a Gaborone sub-region. Methods: Adaptations of the Levesque Access Framework and Woodhead Quality Framework were applied to this qualitative research study. Using semi-structured interviews, 11 pre-primary teachers, 5 school heads or Heads of Department, and 3 Principal Education Officers (PEO) were interviewed, and the data collected was analysed thematically. Results: The findings suggest that the main barriers to the effective pre-primary programme rollout are supply-side and systemic. These barriers represent the public institutional environment (e.g. funding, inter-governmental co-ordination), policy design (e.g. the physical infrastructure delivery model, administrative barriers, enrolment policy), and programme implementation (enrolment practices, teaching personnel, learning materials, and assessment of learners). Conclusion: Although over 600 public schools have implemented the pre-primary programme, meeting the objectives of universal access, equitability, inclusivity, and quality remains a challenge in Botswana, as in many other African countries. Contribution: The findings offer research frameworks and evidence for understanding pre-primary ECCE accessibility and quality. Further, the research has policy, programmatic, and practice-based implications for pre-primary educators and policymakers.