The paper argues that in many developing countries there is a set of linked symptoms in education systems that cohere into what we call a weak foundations syndrome. Multi-source evidence is presented to illustrate how weak foundations through the early years of schooling lead to low primary school completion. Symptoms of the syndrome include (1) low access, use, and quality in preprimary programs; (2) permanently high "apparent" rate of intake (above 100%) into grade 1; (3) over-enrollment bulge, in the early grades, as well as formal and informal grade repetition through primary school; (4) "apparent" large enrollment drop-off between grades 1 and 2. Small stories for Burundi, Madagascar, and Ethiopia are presented to illustrate the syndrome. These cases also identify how countries and international organizations are starting to address the issues. An interesting aspect of the findings is the data that show parents' support for preprimary education by enrolling their children earlier than the normative age for grade 1.