Background: Effective governance of healthcare services is essential for achieving national health objectives and safe quality care. The governance of occupational healthcare services has received scant scholarly attention both globally and in South Africa. This paper uses ILO Convention 155 as a conceptual framework for the review of the governance of occupational healthcare services in South Africa. Objectives: To investigate the nature and extent of involvement of legislated bodies in the governance of occupational healthcare services in South Africa and explore stakeholders’ perceptions of occupational healthcare services governance. Methods: There were three components to the study: a review of relevant legislation and policy documents; 12 key informant interviews; and 11 focus group discussions in three South African provinces. The data were analysed using thematic content analysis. Results: Occupational healthcare services occupy a relatively low priority on the health reform agenda and are delivered in a fragmented and complex legislative framework with multiple government departments tasked with various occupational health functions. The results suggest that there are gaps in governance because of conflicting or overlapping relationships, and poor cohesion among the statutory departments. These, in turn, contribute to poor quality control of occupational healthcare service delivery and insufficient accountability. Conclusion: The improvement of occupational healthcare services governance requires intersectoral collaboration, enforcement of existing legislation, and involvement of all relevant stakeholders.