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Despite recent efforts in Ethiopia to increase health coverage, underutilization of both public and private sectors—the two main sources of formal healthcare—continues. This study gathered ethnographic interviews from 50 patients and 25 healthcare providers and observations of 7 public and private sector hospitals in Addis Ababa, Ethiopia, to identify causes of public and private healthcare underutilization. Analysis of patient and provider narratives revealed patterned itineraries of underutilization, and clear differences in service delivery and quality between the private and public sectors. Both sectors face accessibility issues that negatively affect patient and provider experiences. Public hospitals are congested and underfunded, private hospitals are understaffed and expensive, and both sectors experience constant shortages of medical equipment and drug stocks. The complexity and gaps in the current healthcare system leave healthcare providers overburdened and patients feeling neglected, uncertain, and frustrated. Health-seeker trajectories in Ethiopia’s medically-plural system are characterized by prolonged searches and costly treatment dead ends without any healing or end to suffering; ultimately, this results in complete hopelessness. A conceptual framework is proposed to explain why the quest for healing generates hopelessness for both health seekers and providers. While providers combat hopelessness with referrals to other sites of care, health seekers navigate the precarity of the health system through an economy of affection - a wide range of community relationships of mutuality, and collectivity. This labor has fostered development of third spaces for community organizing and spiritual enlightenment, where suffering is addressed, healing occurs and lost hope is regenerated.
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