From the mid-nineteenth century, the people of the Gold Coast formed an essential component of the missionary and early colonial medical services (CMS). The labour of the people was mainly confined to the category of medical auxiliaries. Enlisting these African auxiliaries into the medical service took place within gendered, racial and class boundaries. Yet, the historiography of the Gold Coast does not overtly address the interplay of gender, race and class in connection with the work of African health auxiliaries. This article examines the intersection of race, gender and class in the employment and training of African health labour in the Gold Coast. It argues that European and African gendered ideologies, racial discrimination and class difference influenced the recruitment of Africans into early colonial and missionary medical services. This article is largely based on qualitative research and critical reading and re-reading of textual records. The records include colonial medical reports obtained from the digital archives of the Wellcome Library in London, Manhyia Archives of Ghana, and Public Records and Archives Administration Department in Kumase of Ghana. Books and dissertations were critically re-examined for fragmented details about these auxiliary workers. This article reveals that men dominated the categories of African health labour, that is doctors, orderlies, dispensers, nurses and midwives until the 1940s when more women began to enter the CMS. The relationship between African and European medical staff, and colonial administrators within the Gold Coast Medical Department from the 1890s shows the existence of racial discrimination largely based on physical appearance and intellectualism. Recruiting Africans into the CMS was necessary to augment insufficient European staffing across many occupations, but not to the same rank and class. This research identifies the pathways into the formalised health professions in Ghana within the context of colonial and missionary medicine.