Thai pharmacy experts define the factors that shape herbal medicine access
Thai pharmacies sit at the intersection of tradition, regulation, and everyday care, and a new e-Delphi study has put structure around a field that has long been described in broad terms. Thirty multidisciplinary experts in Thailand reached consensus on 25 factors relevant to the availability and consumption of herbal medicinal products in pharmacies, giving policy makers and researchers a practical framework for where access begins and where it can break down.
The work matters because herbal medicine use is already deeply embedded in Thai health behavior, yet access is uneven. The national market for herbal medicinal products reached approximately 44.8 billion Baht in 2024, and retail pharmacies account for only about one-fifth of pharmaceutical product distribution in the country, with most distribution moving through hospitals. In that setting, the pharmacy becomes more than a point of sale. It functions as a filter for product quality, a source of advice, and a site where consumer demand meets professional judgment.
The expert panel did not treat access as a simple matter of stocking shelves. Their consensus centered on four domains: the products themselves, the information attached to them, the responsibilities of health professionals, and the operational features of the pharmacy. The most highly endorsed item was the National List of Essential Herbal Drugs, which received a perfect consensus score. In practical terms, that signals that formulary status and national policy are not abstract administrative matters; they are central to whether a product is present, recognized, and recommended in routine pharmacy practice.
Product standards and information carry as much weight as shelf presence
The panel reached consensus on 25 of 34 assessed factors, but the distribution of agreement was uneven and clinically revealing. All nine product-information factors reached consensus, suggesting that experts view information quality as inseparable from safe herbal medicine use. Consumers may encounter herbal products as familiar remedies, but the therapeutic value of those products depends on labeling, indications, dosage guidance, and the clarity of the supporting evidence.
This is where the biological and clinical plausibility of herbal use collides with real-world variability. Herbal products can differ in composition, standardization, and quality, which means the same product category can carry different therapeutic potential and different risks depending on sourcing and regulation. If a pharmacist cannot reliably explain what a product contains, how it is used, or how much evidence supports it, access may exist in name only. The study’s consensus pattern suggests that Thai experts see product information as a prerequisite for appropriate use rather than a secondary accessory.
A single product on a shelf does not guarantee usable access.
Professional competence and recommendation behavior shaped the consensus
The professional domain produced some of the most policy-relevant findings. Consensus was reached on product recommendation, knowledge of HMP categories, and knowledge of evidence-based efficacy and safety. These are not trivial competencies. They define whether pharmacy staff can sort products by regulatory status, explain when herbal use is reasonable, and identify when evidence is weak or safety concerns outweigh expected benefit.
In a setting where herbal products may be sought for self-care, chronic symptom relief, or adjunctive use, recommendation behavior can influence both uptake and misuse. The panel’s emphasis on evidence-based efficacy and safety points toward a pharmacy role that is advisory rather than purely distributive. It also suggests that improving access is not simply about expanding inventory. Professional training and clinical literacy need to advance alongside supply.
The inclusion of both pharmacists and traditional medicine professionals in the expert panel strengthens that interpretation. Twenty-two pharmacists, five Thai traditional doctors, and three medical doctors participated, and all five Thai traditional doctors were affiliated with pharmacies. This mix matters because it reflects the hybrid reality of herbal medicine practice in Thailand, where modern pharmacy systems and traditional medicine frameworks often coexist in the same community setting.
Pharmacy structure influences whether herbal products reach consumers
Operational factors also reached consensus, including pharmacy type, business model, participation in national health programs, and location. Those findings push the conversation beyond individual products and toward the architecture of access. A pharmacy embedded in a national program may have different incentives, stock patterns, and patient flows than an independent retail outlet. Location can shape not only demand but also the kinds of consumers who can realistically obtain herbal products without travel or referral barriers.
This is where access becomes geographic as much as pharmacologic. Thailand’s regional variation in use, affordability, and healthcare patterns has long affected medicine distribution, and the study’s consensus on location supports that reality. Pharmacies in different settings are not interchangeable. Their business models, professional staffing patterns, and relationships with national programs can determine whether herbal products are consistently available or only intermittently offered.
The study was conducted over three rounds between September 2023 and February 2024 using an electronic Delphi process. Round 1 gathered open-ended responses, Round 2 transformed those responses into structured ratings, and Round 3 allowed the panel to reconsider its judgments after receiving group feedback. Consensus required a Quality of the Lower Approximation score of at least 0.75, meaning at least 75% of experts rated both relevance and impact at 5 or higher on the 7-point scale. That approach favors convergence without forcing false precision, which is appropriate for a topic where policy, practice, and consumer behavior intersect.
A framework for future research, not a finished access model
The study’s chief contribution is not a final answer about why herbal medicines are bought or not bought in Thai pharmacies. It is a structured map of the variables most likely to matter. Those variables span policy, information, professional competence, and pharmacy operations, and they create a useful starting point for empirical work that measures how each factor affects stocking decisions, recommendation practices, and consumer uptake.
Because the work relies on expert consensus rather than patient-level outcomes, it cannot show which factors most strongly predict actual use or access disparities. It also cannot determine how much each factor contributes in urban versus rural settings, or how much consumer preference versus professional recommendation drives purchase behavior. What it does provide is a prioritized framework grounded in multidisciplinary judgment, which can guide the next wave of observational studies and intervention design.
For Thai pharmacies, the practical implication is straightforward: herbal medicine access depends on more than supply. It depends on credible product information, trained professionals, and operational settings that support evidence-based recommendation. Without those supports, availability becomes uneven and consumption becomes harder to steer toward safe, informed use.