Construction, Operations, and Sustainability of Maternal and Child Health Pharmacy Clinics in China: A National Multicenter Cross-Sectional Survey

Background 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. Methods 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. Results Ninety valid responses were analyzed (response rate: 62.7%). Among the institutions, 83.3% had established pharmacist-managed clinics and 57.8% operated dedicated MCH clinics. Most institutions (64.4%) provided services free of charge and 61.1% reported operating deficits. Annual patient volumes were highly variable (median 142; IQR 27.5–345.8), with nearly half of the clinics serving fewer than 100 patients per year. Major barriers include low patient willingness to pay and the absence of unified national charging standards. In the 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, clinical duration, and pharmacists’ seniority were not independently associated with sustainability. Conclusions 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.