African relevance

•Sepsis remains a leading cause of preventable mortality across Africa, where delayed recognition of clinical deterioration contributes substantially to poor outcomes.•Early Warning Systems provide pragmatic bedside tools that can support earlier recognition and timely escalation of suspected sepsis using routinely collected physiological observations.•The greatest challenge in African healthcare settings is not adapting physiological scoring systems but integrating them into routine clinical practice through workforce training, structured escalation pathways and context-appropriate implementation strategies.•African implementation experience demonstrates that low-cost, scalable approaches to deterioration recognition can strengthen patient safety and may inform sepsis care in other resource-constrained health systems worldwide.