Effective public investment could potentially improve regional conditions and attract private funding, but bottlenecks in governance currently stand in the way. Since joining the EU in 2004, most public investment in the Slovak Republic has been financed through the EU Structural and Cohesion Funds (now Structural and Investment Funds, ESI). The Slovak Republic received approximately EUR 13.3 billion in EU Structural and Cohesion Funds for the 2007-13 period, and will receive approximately EUR 14 billion in ESI funding for 2014-20. The clear importance of ESI spending makes past practices and future plans with respect to Structural Funds implementation revealing as regards public investment for regional development in Východné Slovensko. Historically low absorption rates for EU funds suggest changes are needed to make better use of the funds for the 2014-20 period. This chapter looks at public investment management in Východné Slovensko directly. It reveals the strengths and opportunities for improvement that exist to make better use of public investment for regional development and inclusive growth. Challenges are in particular linked to: i) top-down orientation of public investment; ii) high local fragmentation; iii) limited private sector engagement; iv) weak sub-national administrative capacities; and complex regulatory framework and procurement conditions.