There's a hot debate in global health right now. And the stakes are high.
Supporters of the pilot program say it has been a success. It slashed the cost of effective drug treatment and boosted its availability.
But some critics argue the program has done more harm than good. It puts drugs in the hands of untrained, unsupervised shopkeepers, who don't know how to diagnose and properly treat malaria.
Today there's a new wrinkle in the debate. Some U.S. researchers have estimated what effect the drug subsidies had in curbing malaria.
Their conclusions don't look promising. They suggest that in many places malaria has been substantially overtreated.
By analyzing a variety of maps and surveys, researchers at the Clinton Health Access Initiative found that private pharmacies have handed out costly malaria drugs indiscriminately to patients with bad fevers without first checking for the parasite.
They estimate that more than 400 million doses of malaria drugs went to people without the disease. In some countries, the number of drug doses "dwarfs the number of actual incident malaria cases that occur," the authors write in the journal Science.
This is double trouble. It means kids with pneumonia haven't been getting treated for their illness and that costly malaria drugs have been wasted.
In a companion commentary, infectious disease doctors at Harvard and Stanford offer a few solutions for fixing the subsidies program, especially when it comes to treating children.
They say pharmacies need to stock up, not only on drugs, but also on malaria diagnostic kits. And, all children should be tested for the parasite before given treatment.
They recommend slowly phasing out the subsidies and spreading out financial support for both medications and testing.