Construction, operations, and sustainability of maternal and child health pharmacy clinics in China: a national multicenter cross-sectional survey

Pharmacist-managed clinics are being promoted nationally in China to strengthen pharmaceutical care, particularly maternal and child health (MCH). However, little is known about how these clinics are structured, staffed, financed, or sustained at a national level. This study examined the development, operational characteristics, and financial viability of MCH pharmacist-managed clinics in China. A national, multi-center, cross-sectional survey was conducted from August to September 2025 among pharmacy department leaders from 150 medical institutions across 32 provinces. A validated 44-item questionnaire assessed institutional characteristics, clinic establishment, service delivery models, workforce composition, financial status, and operational challenges (5-point Likert scales). Descriptive statistics were used to summarize the clinical characteristics. Multivariable logistic regression identified factors associated with financial sustainability, defined as achieving a break-even or profitability. Ninety valid responses were included (response rate: 62.7%). Among the participating institutions, 75/90 (83.3%) had established pharmacist-managed clinics, and 52/90 (57.8%) operated dedicated MCH clinics. Overall, 58/90 (64.4%) institutions provided services free of charge, and 55/90 (61.1%) reported operating at a financial deficit. Only 30/90 (33.3%) institutions charged fees for pharmacy consultations, and only 3/90 (3.3%) reported profitability. Annual patient volumes varied substantially among the 52 MCH clinics (median 142; IQR 27.5–345.8), with nearly half of the MCH clinics (25/52, 48.1%) serving fewer than 100 patients per year. The most reported barriers were low patient willingness to pay (mean score 4.1 ± 1.1 on a 5-point Likert scale) and the absence of unified national charging standards (4.1 ± 1.0). In adjusted analyses, service charging was the strongest predictor of financial sustainability (aOR = 3.85; 95% CI 1.88–7.89), followed by the inclusion of clinic activity in performance-based compensation (aOR = 2.15; 95% CI 1.10–4.20). Institutional characteristics, duration of service provision, and pharmacists’ seniority were not independently associated with sustainability. MCH pharmacist-managed clinics have expanded rapidly nationwide, but the structural misalignment between policy-driven adoption and financial and workforce support has created significant sustainability challenges. Long-term viability requires coordinated reforms, including standardized fee schedules, integration of pharmacist services into insurance reimbursement, and strengthened institutional investment in the workforce and service pathways. These changes are essential to ensure that MCH pharmacy clinics can sustainably improve medication safety and health outcomes for mothers and children.