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OBJECTIVE: To evaluate acute stroke care services in Sindh province of Pakistan. METHODS: This cross-sectional descriptive study, conducted from January to May 2024, assessed stroke care services in hospitals across Sindh, Pakistan. The study included hospitals that admitted more than one stroke patient per month and excluded facilities such as maternity homes and rehabilitation centers. Data were collected via structured proformas from hospital administrators through phone and email, focusing on stroke admissions, acute services, and rehabilitation capabilities. Informed consent was obtained, and ethical approval was granted by the Shifa International Hospital Ethical Committee. Data analysis utilized SPSS version 20 for continuous and categorical variables. RESULTS: Among the 34 surveyed hospitals, 15(44.1%) treated 1 to 10 stroke patients monthly, and 14 (41.2%) admitted over 300 patients annually. Neurologists were on staff in 15(44.1%) of hospitals, and 13 (38.2%) had stroke-trained physicians available 24/7. CT brain scans were accessible 24/7 in 23 (67.6%) of hospitals, with 19(55.9%) prioritizing these scans for stroke patients. Stroke units and 24/7 availability of intravenous tissue plasminogen activator (TPA) were available in 07 (20.6%) of hospitals only. Inpatient rehabilitation facilities were available in 21(61.8%) of hospitals, and 13 (38.2%) collaborated with external rehabilitation centers. Community stroke awareness programs were established in 12 (35.3%) of hospitals, and 09 (26.5%) had designed stroke prevention programs. CONCLUSION: The study highlights significant gaps in acute stroke care services in Sindh, Pakistan, emphasizing the need for improved access to thrombolytic therapy, specialized training, and community awareness programs. [ABSTRACT FROM AUTHOR]