Quick wins versus sustainability: options for the upscaling of insecticide-treated nets.

A review of the main elements determining strategic choices for the large-scale distribution of insecticide-treated nets (ITNs) clearly shows the need for multiple strategies. Mass distributions of free nets provide a unique opportunity to achieve quickly high coverage rates. However, there is also a need for additional approaches to 1) provide continuous provision of ITNs for newly pregnant women and their babies and 2) provide protection for the rest of the population. Targeted subsidies will continue to be an important tool to achieve the first objective, either through direct distribution of ITNs or through vouchers. To achieve objective 2, a strong and competitive commercial sector for ITNs seems to be a good option. It is clear that "one size doesn't fit all," and more experience needs to be gathered and shared. With planning and good promotion campaigns, these strategies can co-exist and re-enforce each other.