The Indian model of allopathic healthcare has been hierarchical, with male doctors from dominant caste groups located at the privileged end of the spectrum, who are highly paid and granted a godlike status, and deserve claps, accolades, and flowers (Agrawal 2020). At the other end of the spectrum are workers, mostly from Dalit communities, who have been delegated to dirty or unclean work associated with sanitation and waste disposal, often performed in exploitative conditions and in a socially distanced manner. In a study on the cleaning staff in public hospitals, Hathi and Srivastav (2020) have documented that, in spite of the public health facilities they visited being in urban or semi-urban areas, cleaning work was assigned to the same marginalised communities that exist in villages, with many workers stating that cleaning work was intergenerational and that others in the family were engaged in similar work. Among the workers we interviewed (Siddharth et al 2020), the cleaning staff and those sweeping the streets were predominantly Dalit women, while the auto-tipper drivers,1 mortuary and crematorium workers were predominantly Dalit or Muslim men.
In India, only allopathic/AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) doctors, nurses, dentists, pharmacists, auxiliary nurses and midwives, community health workers, accredited social health activists (ASHAs), registered medical practitioners, and traditional healers are considered as health workers. In this category of health workers, 38% were female. The male to female ratio was 5.1 for doctors and 0.2 for nurses and midwives. Other paramedical staff and those working as cleaners, sanitation workers, mortuary staff, burial ground workers, and ambulance and mortuary van drivers do not even figure as health workers.