Despite institutional and regulatory frameworks designed to improve health and safety (H&S) performance, the South African construction industry continues to rank among the most dangerous industries since apartheid. The peer-reviewed literature on construction H&S practices in South Africa from 1994 to 2024 is systematically evaluated in this research. 118 pertinent journal articles were found, examined, and grouped into six thematic clusters: safety management practices, risk and hazard factors, regulatory frameworks, worker behavior and culture, training and competence, and digital technologies using the PRISMA method and bibliometric tools like VOSviewer. The review provides practical suggestions for enhancing H&S in construction, highlights important contributors and organizations, and describes the changing research landscape. The findings provide a path for industry stakeholders, legislators, and researchers while highlighting ongoing difficulties in stakeholder engagement, regulatory enforcement, and technological integration.