Transparency International (TI) Pakistan has issued an urgent appeal to the Chief Ministers of Sindh, Khyber Pakhtunkhwa (KP), and Balochistan, demanding immediate action against widespread irregularities in the health sector. In letters sent to the provincial leaders, the organization expressed deep concerns over ineffective regulation and enforcement, which it says has led to the circulation of substandard and potentially dangerous medical products. The warnings follow similar letters previously sent to the Prime Minister and the Chief Minister of Punjab, indicating that the problem spans across the country. TI Pakistan highlighted the unchecked availability of low-quality drugs and the sale of nutraceuticals and alternative medicines without proper formulation or labeling. TI Pakistan’s letters point out that nutraceuticals and alternative medicines are being sold without proper formulation and labeling. The alleged administration of expired cardiac stents at the Punjab Institute of Cardiology was cited as a critical example of the risks involved. The organization noted the alleged failure of drug inspectors to conduct necessary inspections, despite their mandate under the Drug Act. A significant concern is the availability of unregistered veterinary medicines, posing a threat to livestock. TI Pakistan highlighted the alleged lack of effective enforcement despite a considerable number of drug inspectors in the provinces. The organization demanded thorough sampling and testing of all drug categories and called for the identification and legal action against those responsible for expired and unregistered medical devices. Furthermore, TI Pakistan urged the inspection of nutraceutical and alternative medicine manufacturing units and demanded legal action against non-compliant entities. TI Pakistan reiterated its role as a whistleblower operating under the right to information and urged the Chief Ministers to take immediate steps to ensure the availability of safe and quality medicines for the public and livestock in their respective provinces.