Internationalization of higher education in East Africa raises various questions related to its magnitude and intensity, its capacity to address issues of access, equity and regional research and developmental needs. Internationalization and regionalization as processes in higher education can synergize each other but can also limit the success of the other depending on their focus. In East Africa, internationalization has mainly involved new forms of provision of higher education and not necessarily relevant content. At the same time, regional approaches in the context of wider Pan-African concerns on the implications of internationalization in the continent are at play. This paper gives an overview of the two processes. A discussion of the challenges that internationalization of higher education has to regional quality assurance and knowledge production in east Africa is presented.