Reconstructing the professional role of pharmacists in China from the perspective of public value theory: challenges and institutional pathways

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.