BACKGROUND:
Language access is a critical determinant of health equity in multilingual healthcare systems. In South Africa, constitutional and legislative frameworks mandate the use of indigenous languages such as isiXhosa in public health communication. However, inadequate translation practices continue to compromise access to essential health information, informed consent, and patient empowerment.

METHODS:
This study evaluates the quality and effectiveness of isiXhosa translations of two public health artefacts used in clinics in Nelson Mandela Bay: the Patients’ Rights Charter and an Immunisation Poster. Using a qualitative case study design, English and isiXhosa versions of the artefacts were analysed through document analysis, guided by Skopos Theory, Equivalence Theory, and the Social Accountability Framework. Evaluation criteria included grammatical accuracy, cultural and linguistic appropriateness, and functional clarity. No primary participants were involved.

RESULTS:
Findings reveal substantial variation in translation quality. The Patients’ Rights Charter contains frequent literal translations, grammatical and orthographic inconsistencies, and unadapted transliterations that may hinder comprehension and undermine its rights-education function. In contrast, the Immunisation Poster demonstrates culturally responsive and idiomatic language use, employing collective framing and accessible expressions that enhance clarity, trust, and public engagement.

CONCLUSIONS:
The study highlights persistent gaps between language policy and practice in South African public healthcare. Poor-quality translations risk reinforcing health inequities by limiting patients’ understanding of their rights and health choices. Conversely, culturally informed and purpose-driven translation practices can strengthen health literacy and support equitable access to care.