The Andean region presents specific challenges related to its globally important natural heritage, the broad range of pressures on landscapes and ecosystems that accentuate the effects of climate change (CC), and a great diversity of institutional arrangements and policy tools to increase the adaptive capacity of socioecological systems and related disaster risk reduction strategies. In this context, regional readings are needed to generate a multiscale and multisectoral analysis of the responses of Andean countries in public policy and at the grass roots. This paper examines institutional challenges and local perceptions regarding the implementation of CC adaptation policies in the Andean countries. We analyze the regulatory, institutional, and policy framework related to CC policies in Andean countries over the last 5 years. Further, we analyze synergies and opportunities, as well as possible tensions and resistance, that the implementation of CC adaptation policies may generate among diverse actors (civil society organizations, peasant/indigenous communities, and local/regional authorities, among others). For this, we analyze 7 case studies at the subnational level across the Andes. These were chosen to reflect the diversity of local governance contexts across the region and the progress and challenges faced in implementing CC adaptation policies on the ground. This analysis reveals how the implementation of CC adaptation policies in diverse territorial contexts often lacks articulation and coherence with the governance tools and platforms typically used by local actors. In response to this overall limitation, various representative strategies derived from the case studies are highlighted, illustrating different modes of multiactor and multiscale cooperation. Finally, based on our sociopolitical analysis, we propose some key recommendations for the different stakeholders, which could inform the development of an agenda for multiscale and multiactor CC adaptation governance in the region.