The book is the first attempt to investigate how and to what extent authoritarian (personalistic) regimes fail to provide fundamental goods and services. For two decades, Russian authorities spent much effort and money to improve health administration, but most success stories are borderline fake. The failure is by design; because personalistic regimes rely on personalized exchanges and bargains instead of impersonal rules and permanent organizations, all actors put self-interest ahead of patients' needs. It is a severe problem because authoritarian principals proclaim social betterment as their central goal -- and many Russians take such claims at face value -- but incentivize their agents to imitate progress and tolerate slipshod performance. The benefits of this investigation are three-fold. First, the book provides an analytical framework of bad governance rooted in the rational institutionalist tradition and connected to competence-control theory. Second, it gives a general readership interested in how Russia works a sense of the key political players' mindset and the regime-induced constraints under which elites operate. Third, although the book investigates health governance exclusively, its analytical framework is portable to other issue areas and could be applied to explain how and why Russia evolved into an ineffective, coercive, and predatory state under Putin's leadership.

The book is the first attempt to investigate how and to what extent authoritarian (personalistic) regimes fail to provide fundamental goods and services. For two decades, Russian authorities spent much effort and money to improve health administration, but most success stories are borderline fake. The failure is by design; because personalistic regimes rely on personalized exchanges and bargains instead of impersonal rules and permanent organizations, all actors put self-interest ahead of patients’ needs. It is a severe problem because authoritarian principals proclaim social betterment as their central goal -- and many Russians take such claims at face value -- but incentivize their agents to imitate progress and tolerate slipshod performance. The benefits of this investigation are three-fold. First, the book provides an analytical framework of bad governance rooted in the rational institutionalist tradition and connected to competence-control theory. Second, it gives a general readership interested in how Russia works a sense of the key political players’ mindset and the regime-induced constraints under which elites operate. Third, although the book investigates health governance exclusively, its analytical framework is portable to other issue areas and could be applied to explain how and why Russia evolved into an ineffective, coercive, and predatory state under Putin’s leadership.

Although adopting global norms often improves domestic systems of governance, domestic obstacles to norm diffusion are frequent. States that decide to reinvent their political authority simultaneously evaluate which current global norms are desirable and to what extent. In this study, Vlad Kravtsov argues that recent debates about the nature of authority in Putin's Russia and Mbeki's South Africa have resulted in a set of unique ideas on the cardinal goals of the state. This is the first book to explore how these consensual ideas have shaped health governance and impinged on norm diffusion processes. Detailed comparisons of HIV/AIDS governance systems in Russia and South Africa illustrate the argument. The Kremlin's dislike of international recommendations stemmed from the rapidly maturing statism and great power syndrome. Pretoria's responses to global AIDS norms were consistent with the ideas of the African Renaissance, which highlighted indigenousness, market-based empowerment, and moral leadership in global affairs. This book explains how and why the governments under investigation framed the nature of the epidemic, provided evidence-based prevention services, increased universal access to proven lifesaving medicines, and interacted with other participants in social practice.