In considering African health care practice, it is usual to draw strong distinctions between biomedical and traditional practices, and between public and private health institutions. Whilst distinctions between traditional and biomedical, and between public and private medicine make sense from the vantage point of health professionals, we question how far these distinctions are pertinent in shaping health-seeking behaviour given experience of them. This paper argues that other distinctions are becoming far more important to African therapeutic landscapes to the ways that people evaluate the salience of different health providers to their problems. We draw on ethnographic research and illustrative evidence from 1550 ‘infant health biographies’ from rural and urban areas in the Republic of Guinea, where 93% of health expenditure takes place outside the state sector. We outline the distinctions that inform parents' health-seeking practices here. These include distinctions between women's and children's health providers (at state health centres), and those that men frequent (private pharmacies); between familiar ailments with known therapies (whether self-treatment, biomedical or herbal), and unfamiliar ones requiring expert diagnostics (whether from Islamic healers, diviners or doctors); between illnesses treatable by injection, and those aggravated by injection; between types of payment; and between high quality/strong medicines, and poor quality/weak ones. As people engage with emergent therapeutic landscapes, relations of knowledge and expertise, and forms of social solidarity, are emerging with significant implications for potential pathways of health system development, how these are conceptualised, and the forms of citizenship and partnership they might involve.