APT-Sepsis: A Journey of Learning, Collaboration and Change in Uganda
It has been a journey of learning, collaboration, challenges, long days, countless conversations, and, most importantly, a shared commitment to ensuring that mothers do not lose their lives to preventable infections.
The APT-Sepsis project was designed to explore how evidence-based, cost-effective interventions could be embedded into everyday maternity care to strengthen the prevention, early recognition, and management of infection-related complications among pregnant and postpartum women.
Through our work with APT-Sepsis, we had the opportunity to be part of a team working to strengthen the prevention, recognition, and management of maternal sepsis in Uganda. The journey was not always at the bedside, but it remained deeply connected to the people working there; the nurses, midwives, doctors, and other healthcare workers delivering care who ultimately made implementation a success.
The project brought together stakeholders across participating health facilities with one shared goal: to make the timely recognition and response to maternal deterioration a routine part of everyday maternity care.
From Training to Everyday Practice
The APT-Sepsis project incorporated complementary approaches to support infection prevention and the early recognition of maternal deterioration. These included core components of the training such as:
Hand hygiene, guided by the World Health Organization's recommended moments for hand hygiene.
Infection prevention, including vaginal preparation before conducting a caesarean section.
The detection and management of maternal deterioration using the Modified Early Obstetric Warning Score (MEOWS) chart.
However, implementing the APT-Sepsis programme involved much more than introducing tools and protocols. A significant part of the work focused on supporting healthcare workers to understand, adapt, and apply the intervention strategies within their daily clinical practice, to make them part of routine care and support behaviour change.
This required collaboration between the hub team (the core delivery team), healthcare workers, facility leadership, and other stakeholders. It involved logistical preparations, warehouse runs, field visits, supportive supervision, follow-up, and continuous problem-solving to understand what was happening at facility level and respond to emerging challenges.
The work was not always easy. We encountered missed opportunities for early recognition, resistance to changing established practices among some healthcare workers, and logistical challenges. Yet these challenges also provided important opportunities to learn, adapt, and strengthen implementation.
Beyond Implementation: Sharing the Journey
The project went beyond implementation. As the intervention period came to an end, dissemination and knowledge sharing became an important part of the work.
Feedback meetings were organised to bring together different stakeholders and share the journey we had travelled so far. These meetings provided an opportunity to share experiences, celebrate achievements, discuss challenges, and reflect on lessons learned that could inform future maternal health programmes in Uganda.
These conversations were particularly important because implementation is not simply about introducing an intervention; it is about understanding how that intervention fits into the realities of everyday healthcare delivery and identifying what is needed to sustain the changes made.
A 32% Reduction in Maternal Sepsis
Then came a result that made the long days, hard work, and countless hours of effort feel even more meaningful: a 32% reduction in maternal sepsis.
This result was a reflection of the collective effort invested throughout the project. For the hub team, healthcare workers, facility leadership, and stakeholders, seeing the goals of APT-Sepsis translate into everyday practice and seeing that effort reflected in the results was remarkable!
Thirty-two percent is more than a number.
Behind this number are healthcare workers who strengthened their skills and knowledge; hospitals that adopted new approaches; hospital management teams that embraced the project, encouraged their staff to implement the interventions, and conducted internal follow-up; and a hub team that worked through implementation challenges and supported facilities along the way.
Behind the number are also the many small actions that took place every day: a healthcare worker performing hand hygiene, a mother being monitored using the MEOWS chart, a deterioration being recognised earlier, and teams responding more deliberately to signs of maternal illness.
These everyday actions are what helped turn the objectives of APT-Sepsis into practice.
Sustaining the Change
Even though the intervention has ended, the lessons from APT-Sepsis continue to contribute to improved maternal care.
Sites are still making inquiries, requesting additional MEOWS charts, and exploring how MEOWS can be embedded into the new digital EAFYA system. These continued conversations demonstrate an ongoing interest in sustaining and building upon the changes introduced during the project.
By continuing these conversations and supporting health facilities to maintain effective practices, there is an opportunity to further strengthen maternal care and contribute to the prevention of avoidable complications and deaths.
The final site visits were particularly encouraging. It was inspiring to see that the intervention had been sustained in most of the participating facilities. Alcohol-based hand rub (ABHR) dispensers were still mounted on the walls. Healthcare workers were actively performing hand hygiene. Mothers were being monitored using MEOWS charts. Sepsis rates in the wards had reduced, and some sepsis corners were empty.
Most importantly, healthcare workers had stories to share. Stories of what had changed, what they had learned, and how the intervention had influenced their daily practice.
Looking Back, Moving Forward
Looking back, APT-Sepsis was much more than the introduction of a set of interventions. It was a journey of collaboration, learning, adaptation, behaviour change, and ownership.
It reminded us that sustainable change does not happen simply because a new tool is introduced. It happens when healthcare workers understand its value, when facility leadership supports its use, when teams work together to overcome challenges, and when new practices become part of everyday care.
The 32% reduction in maternal sepsis represents the collective effort of everyone who contributed to the project, from the healthcare workers at the point of care to facility managers, stakeholders, and the hub team working behind the scenes.
The project may have come to an end, but the lessons, practices, conversations, and commitment continue.
APT-Sepsis has shown us that meaningful change is built through people, strengthened through collaboration, and sustained through everyday practice.
And perhaps the most encouraging part of the journey is seeing that, even after the intervention has ended, the change continues.
