National pharmaceutical services units (NPSUs) are central government entities, typically embedded within ministries of health, that oversee the pharmaceutical system. Recently, their scope appears to have narrowed considerably. Observational evidence suggests a growing concentration on logistics and supply chain activities, while responsibilities related to pharmaceutical care, regulation, and policy leadership have become fragmented across different structures. This study assessed the current mandates and roles of NPSUs and outlined the essential functions these units should assume in the future. This research drew on comparative case studies from Côte d’Ivoire, Kenya, and Nepal, supported by a comprehensive literature review and qualitative in-depth interviews. Data were triangulated and synthesized to map NPSUs by their hierarchical placement within ministries of health, reporting structures, formal mandates, and operational functions. Across the cases, four broad functional areas were commonly associated with NPSUs: regulation of medicines, procurement and supply chain management, selection and rational use of medicines, and oversight of pharmacy practice. Effective performance of these units depended on three key elements: a clearly defined position within the Ministry of Health hierarchy, an explicit legal or administrative mandate, and supportive national pharmaceutical policies and regulatory systems. A formal legislative framework is necessary to designate at least one NPSU as the steward of pharmaceutical governance. This stewardship role involves system-wide coordination, administrative oversight, and responsibility for designing, implementing, and evaluating policies related to governance, financing, regulation, monitoring, and performance of the pharmaceutical system. Based on these findings, we propose that NPSUs should, at minimum, be responsible for four core areas: pharmaceutical policy and governance, medicine regulation, regulation of pharmacy practice, and procurement and supply chain management. The findings highlight the importance of establishing a dedicated pharmaceutical policy and governance function that provides leadership for the pharmaceutical system, ensures coordination across stakeholders, and strengthens monitoring and evaluation mechanisms to improve overall system performance.
