Insights / Healthcare design research
Hospital categories and levels of care in South Africa
How the Regulations relating to Categories of Hospitals classify public hospitals, and why the category matters before a design brief is written.
A hospital brief begins with its category. The category sets the services the hospital must provide, the patients it receives by referral and the scale of the building. LEMEG Architects prepared this summary from the published regulations as a working reference for its hospital projects.
The five categories
The Regulations relating to Categories of Hospitals, made under the National Health Act 61 of 2003, list five categories of public hospital: district, regional, tertiary, central and specialised. The regulations do not use the numbering Level 1, 2 and 3. That numbering comes from the National Health Insurance (NHI) policy text, which links hospital services to the existing public-sector classification.
| Category (NHI level) | Beds | Services | Referral base |
|---|---|---|---|
| District (Level 1) | Small 50–150; medium over 150–300; large 300–600 | 24-hour district package with general practitioners and clinical nurse practitioners. Specialist services limited to paediatrics, obstetrics and gynaecology, internal medicine and general surgery. | A defined population within a health district. Supports primary health care. |
| Regional (Level 2) | 400–800 | 24-hour internal medicine, paediatrics, obstetrics and gynaecology and general surgery, plus at least one of orthopaedic surgery, psychiatry, anaesthetics or diagnostic radiology. Trauma and emergency services. Short-term ventilation in a critical care unit. | A defined regional population within provincial boundaries. Receives referrals from several district hospitals. |
| Tertiary (Level 3) | 400–800 | Regional services plus the subspecialties of those specialties. Intensive care under a specialist. | Receives referrals from regional hospitals, not limited to provincial boundaries. |
| Central | Maximum 1 200 | Tertiary services and central referral services. Training of health care providers and research are required. | Patients referred from more than one province. Must be attached to a medical school. |
Specialised hospitals are a separate category in the regulations. This summary does not cover them.
What the numbers do not tell you
- Regional and tertiary hospitals share the same bed range of 400 to 800. The regulations distinguish them by service content and referral base, not by size.
- The regulations do not set bed numbers, specialties or room schedules for an individual project. These are settled in the client brief and the room norms agreed with the client.
- The regulations apply to public hospitals. Private hospitals are not classified under them.
Scale of the public system
In reply to parliamentary question NW1137 of 14 April 2026, the National Department of Health reported 254 district hospitals, 46 regional hospitals and 17 provincial tertiary hospitals nationally. Figures for central and specialised hospitals were not complete in the source extract.
Why this matters to the design team
The category fixes the clinical scope that the architect and the engineering disciplines plan for. A regional hospital, for example, must provide 24-hour specialist and emergency services and short-term ventilation, which drives the emergency, theatre and critical care components of the brief.
Sources
- National Health Act 61 of 2003, Regulations relating to Categories of Hospitals, sections 2 to 6.
- National Health Insurance policy text, paragraphs 120 to 123 (levels of care).
- Parliamentary Monitoring Group, Question NW1137 to the Minister of Health, 14 April 2026.