This study aimed to investigate the practices and status of quality service provision in pre-primary schools in Gambella Regional State, Ethiopia. The study was assessed the current practices of pre-primary education, the leadership practices of pre-primary schools, the attachments of pre-primary education with primary schools, and the overall status of quality service provision. A mixed-methods approach was employed, utilizing both quantitative and qualitative methods. Participants included education experts, principals, teachers, and parent teachers’ association leaders. Data was collected through questionnaires, observations, interviews, focus group discussions, and document analysis. The study findings revealed significant deficiencies in the existing practices of pre-primary education in government preprimary schools, despite the presence of policy and standard provisions for pre-primary education in the region. These deficiencies encompassed a lack of implementation guidelines, insufficient provision of age-appropriate teaching-learning materials, limited activities promoting children's interaction, inadequate teacher-student ratios, classrooms that were not adequately sized, poor ventilation, and inappropriate furniture. Additionally, the attachment of pre-primary schools to primary schools posed difficulties, with a preference for establishing pre-primary schools separately. The study also identified concerns regarding the quality of service provision, including low levels of improvement in reading skills, recognition of alphabet letters, children's interest in learning, and parental satisfaction. This study underscores the urgent need for significant improvements in the quality of pre-primary education in government preprimary schools in Gambella Regional State. Addressing the deficiencies in implementation guidelines, teaching-learning materials, teacher-student ratios, classroom size, and furniture suitability is crucial. Furthermore, the establishment of separate pre-primary schools is vital steps towards enhancing the overall quality of pre-primary education in the region.