The International Herald Tribune has a very thought provoking article on a debate over how best to assist the fight against malaria: social marketing vs. direct aid.

Villages like Maendeleo are at the center of a debate that has split malaria fighters: how to distribute mosquito nets.

Recently, Dr. Arata Kochi, the blunt new director of the World Health Organization’s malaria program, declared that as far as he was concerned, “the debate is at an end.” Virtually the only way to get the nets to poor people, he said, is to hand out millions free.

In doing so, Kochi turned his back on an alternative long favored by the Clinton and Bush administrations — distribution by so-called social marketing, in which mosquito nets are sold through local shops at low, subsidized prices — $1 or so for an insecticide-impregnated net that costs $5 to $7 from the maker — with donors underwriting the losses and paying consultants to come up with brand names and advertise the nets.

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The theory behind social marketing, which is also used to distribute condoms and oral rehydration salts, is that the poor see more value in brand-name goods they pay for than handouts they get free, and that the trade creates small entrepreneurs.

The usual comparison made is to Coca-Cola, which reaches Africa’s remotest corners. But Kochi rejected that model, saying, “I’m not sure whether the poorest of the poor actually drink Coca-Cola.”

He argues that the insecticide-filled nets, when used by 80 percent or more of a village, create a barrier that kills or drives off mosquitoes, protecting everyone in the area, including those without nets. Individual nets tended to just drive mosquitoes next door, to bite someone else. As such, he said, nets ought to be treated as a public good, like the measles or polio vaccines, which the world does not charge the poor for.

Free net distributions are usually done in a week or two, by armies of workers who are paid a few dollars a day by the Red Cross or health ministry to cover a country or other large region. Distributions have been tried in Sierra Leone, Niger, Togo and elsewhere, sometimes in conjunction with measles shots or deworming drugs.

The new model is beginning to prevail but has not completely swept the field. Some donors still use some social marketing. Unicef, the world’s largest buyer of nets, distributed 25 million last year, of which 92 percent were given away, said its medical director, Dr. Peter Salama. The main American program, the President’s Malaria Initiative, plans to hand out more than 15 million nets by 2008, of which about 75 percent will be free, said its coordinator, Rear Admiral Tim Ziemer.