EXPLAINER | Medi‑sin of convenience: Over the counter, under the radar

In a bid to empower micro-retailers and broaden healthcare access in geographically isolated and disadvantaged areas (GIDAs), the Department of Trade and Industry (DTI) has proposed a policy that would authorize sari-sari stores to dispense over-the-counter (OTC) medicines such as: paracetamol, loperamide, and antacids, even in the absence of professional pharmaceutical oversight.

Yet beneath the language of empowerment simmers a growing unease among healthcare professionals. The controversy extends beyond questions of regulation; it probes deeper into the architecture of habit, the psychology of trust, the calculus of risk, and the fraught ethics of convenience.

Said in a 2024 press release, Trade Secretary Alfredo Pascual framed the initiative as a dual-pronged effort to "empower over one million sari-sari store owners across the Philippines by equipping them with digital tools, knowledge, and sustainable practices" and to “see sari-sari stores not just survive but thrive.” Cast as pro-poor, pro-health, and pro-growth, the proposal is positioned at the intersection of public welfare and market empowerment.

Yet in a July 4 interview with the Daily Tribune, the DTI clarified that the over-the-counter medicine push remains a proposal under study — with no formal guidelines issued and consultations with the FDA and local stakeholders still underway.

To healthcare advocates, however, the scheme threatens to reduce health access to a matter of retail logistics, overlooking the fact that, at its core, it is a safety-critical public service, not a commodity to be casually dispensed.

“Sari‑sari stores do not have registered and licensed pharmacists to make sure that the medicines being dispensed are acquired, stored, and dispensed with quality,” said Dr. Kenny Merin, president of Philippine Pharmacists Association (PPhA)‑Davao.

In operant conditioning, B.F Skinner outlines a behavioral loop: cue, craving, response, and reward, that governs everyday actions. Sari-sari stores, embedded in the social and spatial fabric of communities, offer potent cues: they are accessible, habitual, and culturally familiar. For many, purchasing medicine from a tindera is not only more expedient and convenient but also imbued with a sense of comfort absent in the distant, clinical setting of a formal pharmacy.

“’Pag sa bayan, mamamasahe pa; lalayo pa. Gabi na, wala ka nang masakyan,” said Catherine, a resident of a remote barangay, highlighting how mobility constraints drive communities to rely on sari-sari stores for basic medication needs.

But this convenience becomes a cognitive shortcut. As the behavior repeats, self-medication becomes the default, even when symptoms may signal something more serious.

A 2022 GMA News report quotes then-DOH officer-in-charge Dr. Ma. Rosario Vergeire warned that the rise in antimicrobial resistance in the Philippines is fueled by the country’s entrenched culture of self-medication, especially in underserved communities.

Behavioral studies echo the concern: national surveys place self-medication rates between 31% and 66%, with many Filipinos misdiagnosing symptoms or using incorrect dosages.

As noted in The Lancet Regional Health (2022), this trend delays clinical intervention and accelerates drug resistance, making routine infections harder—and costlier—to treat.

“Medicine can heal, but it can also kill… dispensing of medicines… must be done under direct and immediate supervision of a pharmacist,” the PPhA warned in April 2021, responding to mass Ivermectin distribution efforts. 

In unregulated environments, expired medications, unstable storage conditions, and undetected drug interactions slip through unnoticed risks the sari-sari store, however socially trusted, is neither equipped nor authorized to manage.

Interpersonal trust plays a pivotal role in shaping health-seeking behavior across Filipino communities. A 2020 survey in SSM – Population Health revealed that trust in family members and neighbors significantly increased rural health unit visits for tuberculosis screening.

Likewise, a 2022 qualitative study observed residents in underserved barangays often turned to over-the-counter medications from sari-sari stores, not merely out of necessity, but driven by a potent mix of convenience, interpersonal familiarity, and longstanding social trust.

This reflects familiarity bias at work: in high-stakes decisions, people tend to place trust in those within their social orbit. It’s not a matter of ignorance; it’s a psychological tendency rooted in perceived safety and relational proximity.

Pharmacists readily support bridging GIDA healthcare gaps, but they stress that access without accountability undermines patient safety. Medicines require expert oversight: dosage, contraindications, interactions, and proper storage — none of which sari-sari stores, despite their local trust, are equipped to provide.

As civil rights advocate Bakari Sellers once wrote: “The idea of health equity is about meeting people where they are, providing them with quality care no matter their backgrounds.” 

This is where ethics enters: Is it just to expand access if it endangers the very people it claims to help?

India’s once-lax policy on OTC antibiotic sales led to rising drug resistance and poor compliance. In 2014, the government introduced Schedule H1, tightening regulations and restricting access to critical antibiotics effectively rolling back its earlier stance.

In contrast to India’s earlier liberal OTC antibiotic policy, Thailand bolstered rural drug safety through a strategic model: by training local pharmacists and deploying community pharmacy frameworks. Since the 2007 Antibiotics Smart Use (ASU) campaign and the 2017 national AMR strategy, Thai pharmacies have been empowered to offer evidence-based triage and counseling integral to antimicrobial stewardship in both urban and rural settings.

This contrast underscores a key lesson: accessibility without structured accountability tends to erode public health safeguards, while access coupled with pharmacist-driven literacy fortifies them.

Public health experts propose a spectrum of safer alternatives:

Access is not the enemy, but it must be paired with education and oversight.

DTI’s proposal tackles a real problem: healthcare deserts in far-flung communities. But the solution, critics warn, could entrench a dangerous behavior loop: valuing convenience over caution, speed over safety.

And in a country where health decisions often happen in informal settings, behavioral science matters as much as policy science.

In health, shortcuts don’t just save time; they can cost lives. And as regulators weigh empowerment against precaution, the real challenge lies in creating systems that don’t force Filipinos to choose between access and safety.