Lost in translation: Language and implementation gaps in South African patient-held records

Patient-held records like South Africa’s Road-to-Health Booklet (RtHB) and Maternity Case Record (MCR) support continuity of care by serving both clinical documentation and patient education functions. However, patient-directed educational content is predominantly available in English. To explore how language accessibility influences patient engagement with patient-held records and to identify implementation gaps in multilingual patient education across maternal and child health services, public sector primary healthcare clinics and district hospitals in South Africa. Reflective analysis combines clinical experience and a review of national patient-held records. Patient-directed educational content within patient-held records is predominantly in English, limiting accessibility for many patients and caregivers in South Africa’s multilingual context. Child health services include a multilingual educational companion alongside the RtHB although its implementation appears inconsistent. In contrast, no routinely implemented multilingual educational companion exists for the MCR despite expectations that patients understand danger signs and management plans. Contribution: The principal gap lies not in the absence of multilingual educational models but in their inconsistent implementation. Strengthening multilingual patient education within patient-held records could improve patient engagement, support health literacy and promote more equitable healthcare communication.