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Learn more: PMC Disclaimer | PMC Copyright Notice J Pharm Policy Pract . 2026 Apr 14;19(1):2654488. doi: 10.1080/20523211.2026.2654488 Search in PMC Search in PubMed View in NLM Catalog Add to search Reconstructing the professional role of pharmacists in China from the perspective of public value theory: challenges and institutional pathways Kexin Han Kexin Han a Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China Find articles by Kexin Han a, CONTACT , Shushan Wu Shushan Wu a Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China Find articles by Shushan Wu a , Fanghui Lin Fanghui Lin b International Research Center for Medicinal Administration, Peking University, Beijing, People’s Republic of China Find articles by Fanghui Lin b , Xiaoyan Nie Xiaoyan Nie a Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China b International Research Center for Medicinal Administration, Peking University, Beijing, People’s Republic of China Find articles by Xiaoyan Nie a, b , Luwen Shi Luwen Shi a Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China b International Research Center for Medicinal Administration, Peking University, Beijing, People’s Republic of China Find articles by Luwen Shi a, b , Xiaodong Guan Xiaodong Guan a Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China b International Research Center for Medicinal Administration, Peking University, Beijing, People’s Republic of China Find articles by Xiaodong Guan a, b Author information Article notes Copyright and License information a Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China b International Research Center for Medicinal Administration, Peking University, Beijing, People’s Republic of China CONTACT Kexin Han [email protected] #38 Xueyuan Road, Haidian District, Beijing, People’s Republic of China Received 2025 Nov 15; Accepted 2026 Mar 29; Collection date 2026. © 2026 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/ ), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent. PMC Copyright notice PMCID: PMC13081338 PMID: 41994226 ABSTRACT Background China's transition toward people-centered health governance has highlighted the essential role of pharmacists in ensuring rational medication use and protecting public health. However, pharmacists' professional roles remain fragmented across institutional, social, and regulatory dimensions. Drawing on public value theory, this study examines the structural and cognitive misalignments constraining pharmacist professionalisation in China and situates these challenges within an international context. Methods This study employed a literature-based conceptual analysis informed by public value theory. National laws, administrative regulations, policy documents, and scholarly studies were reviewed to examine how public value – specifically value consensus, legitimacy and support, and operational capacity – is reflected in pharmacist governance. Evidence from existing empirical studies was integrated to illustrate gaps in public cognition, administrative coordination, and professional self-identity, with their scope and limitations qualitatively appraised. Results Three interrelated challenges were identified. First, fragmented administrative governance across regulatory bodies leads to inconsistent legal definitions, unclear role boundaries, and limited institutional authority for pharmacists, particularly in clinical decision-making and medication therapy management. Second, public awareness of pharmacists’ professional value is insufficient; survey evidence indicates that patients largely associate pharmacists with dispensing or sales functions, leading to low social demand for pharmaceutical care and inadequate legitimacy for role expansion. Third, pharmacists demonstrate inconsistent professional self-identification: many hospital pharmacists prioritise logistical tasks, while most community pharmacists remain oriented toward commercial rather than patient-centered service roles. Together, these structural, cognitive, and professional gaps undermine value consensus, legitimacy, and operational capacity within the pharmacist ecosystem. Conclusion Advancing pharmacist professionalisation in China requires integrated legislation and cross-sectoral governance, enhanced public communication and health literacy, and strengthened professional competencies supported by adequate incentives. These findings echo international experiences, highlighting pharmacist professionalisation as a shared global governance challenge rather than a China-specific issue. KEYWORDS: Pharmacist professional development, pharmacists, pharmacist role, pharmacist law Background Health is a fundamental element of socio-economic development and a core component of national well-being. In China, the Healthy China 2030 strategy elevates health to a policy priority and highlights preventive care, public participation, and integrated care delivery as the foundation of sustainable health governance (Tan et al., 2017 ). Within this evolving healthcare system, pharmacists play a critical role in ensuring medication safety and optimising drug therapy outcomes. Despite their importance, the pharmacist's professional role remains under-defined in China both institutionally and socially. Pharmacists occupy a structurally ambiguous position: their responsibilities vary across settings, are governed by different authorities, and lack consistent legal or professional standards. Ongoing legislative efforts to formulate a Pharmacist Law reflect the government's intention to standardise and elevate the profession (The State Council of the People’s Republic of China, 2024 ); however, fragmented administrative functions, insufficient public recognition, and weak professional self-identity continue to hinder role institutionalisation. In this context, Moore's Public Value Theory provides a suitable analytical framework for reconstructing the pharmacist professional ecosystem. Public value theory reconceptualizes the purpose of public governance as the creation of societal value – rather than the mere production of administrative outputs – and emphasises the interdependence among three elements: (1) public value creation; (2) legitimacy and support; and (3) operational capacity (Moore, 1995 , 2013 ). When applied to China's health governance, this framework highlights the need for a public coordinator to reconcile state institutions, healthcare professionals, and the public in achieving collaborative health system objectives. Recent studies further suggest that such coordination depends on achieving three layers of consensus: value consensus, which establishes shared goals such as safeguarding public health and promoting rational medication use; normative consensus, which clarifies rights, duties, and professional standards; and interest consensus, which ensures proper distribution of benefits and responsibilities among stakeholders (Fu et al., 2024 ). Legal codification – such as through the development of the Pharmacist Law – provides a mechanism to institutionalise these consensuses, transforming public value commitments into enforceable norms that enhance policy legitimacy, strengthen professional recognition, and improve service effectiveness. Extensions of the theory by Benington and Sancino further underscore the shift from hierarchical administration to multi-actor collaborative governance, a model well aligned with China's transition toward an integrated, people-centered healthcare system (Benington & Moore, 2011 ; Sancino, 2022 ). Guided by this framework, this study analyzed the divergent expectations of government, the public, and pharmacists, identified key structural and cognitive barriers, and proposed strategies to reconstruct a coherent, value-oriented professional ecosystem that aligns with China's broader health governance goals. Methods Data sources This study employs a literature-based and conceptual analytic approach guided by public value theory. Multiple sources of evidence were reviewed, including national laws, administrative regulations, policy documents, professional guidelines, and peer-reviewed scholarly literature related to pharmacist governance and professional practice in China. Legal and policy documents were identified through official government and regulatory portals, including the National People's Congress, the National Health Commission, the National Medical Products Administration, and related ministerial websites. Scholarly literature was identified through searches of CNKI and PubMed. Searching criteria and analytical approach The search covered the period from January 2000 to October 2025 and used keywords including ‘pharmacists’ role,’ ‘pharmaceutical care,’ ‘pharmacist regulation,’ ‘professional role,’ ‘professional identity,’ and ‘public value theory’ with Chinese and English equivalents. Documents were included if they addressed pharmacist roles, governance arrangements, public perceptions, or professional identity in hospital or community settings. Materials focusing exclusively on technical pharmaceutical sciences or unrelated professional groups were excluded. Given the conceptual and policy-oriented aim of the study, this review followed a transparent narrative selection process rather than a formal systematic review. The objective was to synthesise representative and policy-relevant evidence across institutional, social, and professional domains, rather than to exhaustively capture all empirical studies. Consequently, a PRISMA-style flow diagram was not applied. Survey evidence from existing empirical studies was incorporated to illustrate gaps in public cognition and professional self-identification. These surveys were qualitatively appraised based on reported study setting, geographic scope, and year of data collection, and key limitations. An overview of survey characteristics, scope, and key limitations is provided in the Supplemental Material . The analysis followed a deductive, theory-driven approach guided by the three domains of public value theory: value consensus, legitimacy and support, and operational capacity (Moore, 1995 , 2013 ). The unit of analysis included individual laws, policy documents, and empirical studies. Evidence was examined and mapped to these domains based on the primary governance issue addressed, such as role definition, authority allocation, public recognition, or professional capacity. Interpretation was conducted iteratively by the research team, with differences in classification resolved through discussion to reach consensus. Given the conceptual and integrative aim of the study, the analysis focused on thematic coherence rather than formal coding frequency or inter-rater reliability testing. Results Fragmented administrative consensus Pharmacist governance in China remains structurally fragmented. National legislation defines hospital pharmacists mainly through operational responsibilities such as medication dispensing and distribution. For example, the Drug Administration Law refers to ‘pharmaceutical personnel’ primarily from the perspective of institutional duties, without specifying the individual responsibilities, rights, or obligations of pharmacists ( Drug Administration Law , 2019 ). Similarly, the Basic Medical and Health Promotion Law outlines only general principles and codes of conduct for pharmacists, offering no precise definition of pharmacists’ professional functions ( Law on Basic Medical and Health Care and Health Promotion , 2019 ). Other ministerial regulations further illustrate this gap: although documents such as the Administrative Measures for Prescription Management describe tasks in reviewing, evaluating, verifying, and dispensing prescriptions, they do not establish professional status, evaluation mechanisms, or clearly delineated rights and obligations (Ministry of Health [MOH], 2007 ). Even the Provisions on Pharmaceutical Affairs Administration in Medical Institutions , which set staffing and management requirements, remain ministerial guidelines rather than legally binding rules and thus lack enforceability (Ministry of Health et al., 2011 ). Consequently, hospital pharmacists lack sufficient institutional authority to participate in clinical decision-making or medication therapy management. In parallel, however, the national drug regulatory authority regulates licensed (community) pharmacists through qualification examinations and retail supervision. Although these documents emphasise pharmacists’ role in supervising drug use across production, distribution, and utilisation, they fail to articulate practice-specific duties – particularly within community pharmacy and online retail environments (National Medical Products Administration & Ministry of Human Resources and Social Security, 2019 ). This contributes to ambiguity in service expectations and sharp inconsistencies between the clinical orientation of hospital pharmacists and the commerce-oriented expectations placed on community pharmacists. These fragmented regulatory structures have entrenched a dual-track system with unclear role boundaries, limited professional autonomy, and weak alignment with national priorities for rational medication use and patient-centered care. From a public value perspective, Chinese pharmacists lack a unified consensus on their rights and responsibilities, which undermines public administrators’ ability to guide systemwide planning, policy alignment, and stakeholder coordination. Consequently, the absence of administrative consensus hinders clear role definitions and delays the legal institutionalisation of professional standards. Insufficient public awareness and recognition Public understanding of pharmacists’ professional contributions remains limited. Prior survey indicated that most patients and their family members were unfamiliar with the roles and responsibilities of hospital pharmacists. More than four-fifths of respondents (81.31%, n = 198 ) believe that hospital pharmacists’ primary duty is to dispense medications, and they do not perceive pharmacists as capable of addressing drug-related problems. Consequently, when faced with medication-related questions, nearly nine-tenths of respondents (89.90%, n = 198 ) reported that they would consult physicians rather than pharmacists (Chen et al., 2017 ). Perceptions of community pharmacists are even more constrained. Over 90% of respondents (92.31%, n = 775 ) believe that the primary task of pharmacists in drugstores is simply ‘to hand out and sell medicines’ (Lü, 2017 ). This perception reflects longstanding confusion between sales roles and professional responsibilities, particularly in retail pharmacy environments where business performance remains prioritised over care provision. From the perspective of public value theory, the public – acting as the demand side of healthcare services – lacks a unified cognitive framework for understanding pharmacists’ roles and the scope of pharmaceutical services. They neither fully grasp the distinctions between hospital pharmacists and community pharmacists, nor recognise pharmacists as integral members within the healthcare system. These cognitive gaps reduce the social demand for pharmaceutical care, weaken legitimacy for expanding pharmacists’ responsibilities, and prevent the formation of a shared public expectation that would support pharmacists’ integration into the clinical multidisciplinary care team. Inadequate professional self-identification Pharmacists’ internal perceptions mirror the external fragmentation. Within hospital settings, pharmacists’ understanding of their professional duties varies significantly by job function. Those working in logistical or dispensary positions tend to focus on drug supply and distribution, displaying limited awareness of the value and content of pharmaceutical care (Yuan et al., 2023 ). Clinical pharmacists, although more aligned with patient-centered care, remain a small proportion of the pharmacy workforce, and even among them, a notable portion (23.5%) still conceptualises their work as laboratory or research functions rather than direct patient care (Huang et al., 2015 ). In contrast, licensed community pharmacists remain more closely aligned with a traditional, commerce-oriented paradigm. Empirical study showed that only about one-fifth of community pharmacists identified their responsibilities as providing pharmaceutical services such as prescription review (23.89%), medication counselling (24.82%), or adverse drug reaction monitoring (11.94%). In contrast, over 90% (92.04%; n = 775 ) still perceive their primary function as drug sales (Lü, 2017 ). This pattern indicates that the professional transformation of community pharmacists – from a commercial to a care-oriented identity – remains largely incomplete. Such cognitive fragmentation weakens intrinsic motivation, limits participation in collaborative care, and ultimately restricts pharmacists’ ability to contribute to public health goals. From a public value perspective, this reflects a lack of value consensus and operational capacity within the profession. Discussion The findings reveal that the challenges facing pharmacist professionalisation in China stem not merely from technical or administrative shortcomings but from deeper structural, cognitive, and normative misalignments. Applying a public value perspective highlights that pharmacist development must be understood as a process of value co-creation, requiring coordination across government, professionals, and the public. The discussion below synthesises these insights and proposes multi-level strategies for building a coherent professional ecosystem. Strengthening institutional foundations through integrated governance The fragmented regulatory landscape identified in the Results section suggests the need for unified institutional design. Establishing a Pharmacist Law is not only a legislative task but also a mechanism to crystallize value, normative, and interest consensus across government agencies. Such legislation should clarify pharmacists’ decision-making authority, delineate their clinical responsibilities, and establish a consistent evaluation and accountability framework across practice settings. Beyond legislation, integrating health, drug regulation, insurance, education, and human resources functions is essential for coherent policy implementation. Cross-sector mechanisms – supported by digital information platforms – would enable prescription traceability, enhance regulatory oversight, and allow pharmacists to play a more impactful role in medication therapy management. By strengthening institutional coordination, the system can better align resources, expectations, and professional roles. Reshaping social cognition through strategic communication and public engagement Insufficient public recognition of pharmacists’ expertise underscores the need for systematic cognitive reshaping. Public value theory emphasises legitimacy and support as essential components of value creation. In the Chinese context, this means building stronger public expectations around pharmaceutical care. Health authorities, academic institutions, and media platforms could collaborate to highlight pharmacists’ contributions to rational medication use, chronic disease management, and prevention programmes. Effective science communication – particularly through digital and community-based channels – can correct misconceptions, encourage the public to seek pharmacist-led services, and strengthen social demand for professional pharmaceutical care. Increasing public engagement also creates a feedback loop that reinforces policy legitimacy and supports broader professional reforms. Cultivating a service-oriented professional identity through practice-specific competencies The inconsistency in pharmacists’ self-identification revealed in the study points to a need for differentiated but interconnected competency development. Hospital pharmacists should be empowered with advanced skills in evidence-based pharmacotherapy, clinical decision support, and specialised services such as oncology or intensive care. Community pharmacists should focus on chronic disease management, health screening, and medication counselling – functions that position them as accessible health gatekeepers. Building such competency frameworks also helps transform internal professional identity: as pharmacists become more visible contributors to patient outcomes, their sense of professional value and commitment to continuing development will grow. In turn, this strengthens the profession’s operational capacity, completing the public value triad. Aligning interests for sustainable professional ecosystems A sustainable professional ecosystem depends on ensuring that institutional incentives, public expectations, and professional motivations are aligned. Pharmacist services must be appropriately reflected in performance evaluations, reimbursement policies, and career progression pathways. Collaborative practice models – where pharmacists work alongside physicians and nurses – can institutionalise shared responsibilities and reinforce recognition of pharmacists as essential contributors to patient outcomes. When interests are aligned across stakeholders, pharmacists can fully engage in co-producing public health value, and the healthcare system can better leverage their expertise to improve medication safety and overall care quality. International context and global relevance Although this study focuses on China, the challenges identified are not unique to the Chinese context. Recent international research demonstrates that pharmacists in multiple countries face similar difficulties related to professional autonomy, fragmented identity, and limited public recognition, underscoring the broader relevance of our findings. Two recent studies from a Scottish academic group closely mirror our results. Research on collective professional autonomy describes pharmacists as operating within a condition of ‘independence within interdependence,’ where formal responsibilities expand without corresponding decision-making authority (Forsyth et al., 2026 ). This parallels our finding that Chinese pharmacists are assigned increasing responsibilities for medication safety and rational use but lack clear institutional authority, particularly in clinical decision-making. Likewise, an international systematic review on alienation and anomie among pharmacists reports widespread experiences of role fragmentation, weak public recognition, and deprofessionalization across countries (Forsyth et al., 2025 ), closely reflecting the fragmented governance, low public awareness, and weak professional self-identification observed in China. Similar patterns have been documented in other settings. Studies from Canada and England show that pharmacists’ professional identity is often unstable and contested, shaped by tensions between clinical, technical, and commercial roles (Kellar et al., 2021 ; McDermott et al., 2023 ). These findings align with the divergence observed in China between hospital pharmacists’ logistics-oriented roles and community pharmacists’ commerce-oriented practices. Across contexts, the absence of a clear and shared understanding of pharmacists’ professional value undermines legitimacy, limits autonomy, and constrains meaningful role expansion. Taken together, these international parallels suggest that pharmacist professionalisation is a global governance challenge rather than a country-specific issue. From a public value perspective, misalignment between institutional design, public expectations, and professional self-concept weakens value consensus, legitimacy, and operational capacity. Embedding the Chinese experience within this international literature highlights the wider applicability of our public value framework and reinforces the need for coordinated institutional, social, and professional strategies to support pharmacists as co-producers of public health value. Limitations This study is theory-informed and interpretive, using public value theory to synthesise legal, policy, and empirical evidence rather than to establish causal relationships. Although evidence was triangulated across multiple sources, the narrative and policy-oriented selection process may not have captured all relevant studies, and alternative theoretical perspectives could yield complementary interpretations. Survey findings were used illustratively and are subject to limitations related to geographic scope, sampling, and self-report bias, and should not be interpreted as nationally representative. Finally, the macro-level focus precluded formal negative-case analysis; future research combining theory-driven analysis with nationally representative and comparative designs is warranted. Conclusion Pharmacists play a critical yet under-recognized role in China's evolving healthcare system. Fragmented regulation, insufficient public awareness, and inconsistent professional self-identity hinder their ability to fully contribute to public health. These barriers are not unique to China but shared globally. Applying a public value perspective illuminates these challenges and provides a coherent framework for intervention. Through legislative reform, cognitive reshaping, and capability development, it is possible to reconstruct a pharmacist professional ecosystem that strengthens public trust, enhances professional recognition, and supports China's broader goal of building a high-quality, people-centered healthcare system. Supplementary Material Supplemental Material JPPP_A_2654488_SM0071.docx (14.3KB, docx) Disclosure statement No potential conflict of interest was reported by the author(s). Supplemental Material Supplemental data for this article can be accessed online at https://doi.org/10.1080/20523211.2026.2654488 . References Benington, J., & Moore, M. H. (Eds.). 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