This article reviews the governance and management of MPAs in terms of their size and location, the type of MPA, zonation schemes and financial status. The successes of different types of MPAs are discussed based on specific indicators such as changes in biodiversity, infrastructure, compliance to regulations and the level of involvement of primary stakeholders in the management. From the review, it is clear that a fourth generation of MPAs, community based MPAs may be forthcoming. The major issues facing MPAs in the region are highlighted, as well as some regional initiatives striving to address these issues. A number of recommendations are made, aiming to strengthen the establishment and management of MPAs in the eastern African region.