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Preprint Review "The emerging civil societystate nexus in Putin's Russia: a case study in public health" by Vladislav A. Plotnikov

This paper focuses on one particular group of stakeholders – the non-profit organisations that, while crucial, remain poorly understood in Russia. The main objective of the research is to understand why and how the priorities of Russian NGOs in the health sphere (e.g. professional medical organisations and patient groups) differ from policymaker priorities. A particular focus of this paper is to explore the composition and types of activity of the federal and regional Public Councils operating in the health sphere.

The financing of the health system was modernized in 2010 with the adoption of a new law on compulsory medical insurance. However, as of 2017, the main principles, values and goals of the Russian health care system are still under discussion. The role of non-profit organisations in this sphere remains poorly defined and little understood, following the introduction of a controversial 2012 law restricting the role of foreign funding of Russian NGOs. The transformation of priorities and the associated reactions of stakeholders (e.g. professional medical organisations, clinicians, pharmaceutical companies, patient groups) to the new challenges will significantly shape the future evolution of the health sector in Russia.

NGO activities in the health sector in Russia represent an unusual example, with influential stakeholders formed through non-commercial partnerships with pharmaceutical and medical equipment manufacturers and authoritative patients’ organisations. There is also a wide range of treatment providers: state, public-private and non-profit clinics and hospitals. In this article author tracks how NGO activities in the health sector have sought to work around state policy obstacles to become influential in the decision making process.

The paper contributes in many major ways. First, the Public Council under the Federal Ministry of Health serves as a good example for progressive regions (e.g. Saint Petersburg, Tyumen, Saratov, Samara, Rostov regions) in which all the Council consists of non-officials: NGOs, clinicians, pharma companies. Meanwhile, most of the subjects of the Russian Federation continue to try to control the make-up of Public Councils, especially in the republics and in central federal district.

The analysis helps us to understand that there is no interdependence between the quantity of NGOs registered in a 19 particular region and the representation of such organisations in Public Councils; it commonly depends on different issues, such as the participation of officials in Public Councils, and the communication links between authorities and NGOs. The less state control we found within Public Councils in the regions (Saint Petersburg, Samara, Sverdlovsk region) the more NGOs participated in these structures and found opportunity to establish their developments.

Thus, it can be said that the state now governs the non-profit sector, even though it also promotes the non-political activities of NGOs as “allies in solving social problems.” This is further confirmed by the effects that the amendments in Law on NGOs (2012) has had. On the one hand it restricted access for most NGOs to communication with official institutions and fundraising in Russia and beyond while, on the other hand, it made the Government and regional authorities enhance their budgetary support for NGOs. So, “health behaviour and healthcare” became one of nine spheres of funding at the federal level.  New forms of social cooperation appear after the Law on NGOs  (2012)  which fall into actual model of crucial state control. The examples of such cooperation are: League of Nation's Health, All-Russian Public Organization of Disabled Patients with Multiple Sclerosis. In order to have a chance to cooperate with authorities these organisations’ tried to obtain seats in federal and regional Public Councils. Public Councils now adopt a role of support for institutions and have become some kind of channel for representing the interests of NGOs and society in the health sphere.