Leadership and governance of Sierra Leone’s Directorate of Pharmaceutical Services (DPS) is a key pillar of the health care system. The DPS plays a key role in providing technical guidance and setting the strategic direction for policy formulation, service delivery, standards, laws and regulations, and objectives. It is also involved in stakeholder collaboration and coalition building, monitoring and oversight, resource mobilization, and resource deployment. The DPS is expected to provide leadership and manage the efforts of pharmaceutical health care providers, particularly pharmacy personnel, to ensure that strategic goals and objectives are accomplished at all levels. It was therefore necessary to review the DPS structure at all levels, especially with regard to the ongoing decentralization process and capacity needs.