We Can’t Scale What We Can’t See: Why PPH Routine Data Measurement Matters

The January 2026 blog, Preventing Postpartum Hemorrhage for Every Woman, Wherever She Gives Birth, highlighted the critical need to scale access to medicines for PPH prevention. PPH is still the leading cause of maternal death worldwide, with about 14 million women experiencing PPH every year, leading to about 70,000 maternal deaths. This doesn’t have to be the case. Quality-assured PPH products exist and evidence-based guidelines are in place to support PPH prevention, detection, and treatment. However, introducing and scaling new clinical protocols can be a complex and, oftentimes, slow process. 

Catalyzing adoption of effective drugs and approaches for PPH prevention and treatment requires much more than procuring new medicines and training healthcare workers.  It requires consideration of all health systems building blocks – including strengthening routine health information systems and equipping clinical teams to routinely track and measure care processes and outcomes. Initially, this helps health workers and decision-makers see the impact of new interventions on women’s lives, over time it provided critical information on progress and impact. Since 2022, the Unitaid-funded Accelerating Measurable Progress and Leveraging Investments for Postpartum Hemorrhage Impact (AMPLI-PPHI) project has supported Ministries of Health (MOH) and collaborated with national and health worker professional associations to implement WHO recommendations on the use of heat-stable carbetocin (HSC) for the prevention of PPH and introduce the E-MOTIVE bundle for early detection and treatment of PPH. This blog shares experiences from multiple countries involved in the project and shows why strong metrics and measurement systems are essential for bending the curve on PPH and saving mother’s lives.  

Why Measurement Is Important 

Evidence shows that supported, regular health data use can strengthen motivation and empower change, but if not supported or reinforced, it can lead to blame, fear, and data manipulation. It’s crucial to track how well new protocols and interventions are working within national health systems. Measurement helps healthcare workers change their practices and adopt new habits. Measuring new interventions demonstrates effectiveness, shows the impact of these treatments, and justifies government and donor financial support. Collecting this data is especially vital when new treatments are being introduced.  

Improving Measurement at Health Facilities 

HSC and E-MOTIVE are new, and we need standard ways to measure how well they’re being used. Measuring impact is essential to making national-level decisions on which interventions to prioritize. When AMPLI-PPHI started in 2022, no countries’ maternity registers recorded how PPH was managed, including the specific medications or treatments used. The information we had about PPH prevention, detection and treatment was inconsistent between countries. Without this vital data, it was tough to understand how well these treatments were being used or what impact they were having. 

To help improve the routine measurement of new interventions, new medications being used, and the outcomes, project teams introduced supplemental reporting tools at the health facilities where these interventions were being rolled out. For example, they modified facility registers to capture use of HSC instead of oxytocin when cold-storage conditions were unreliable. Revised tools also captured introduction of E-MOTIVE, which moves from estimating blood loss to accurately and objectively measuring it with calibrated drapes, and to treat PPH using a WHO-recommended bundle of interventions delivered in short succession, rather than waiting for one to work or not before adding another.  

Improving routine reporting at the facility level included working closely with health facility data managers to increase adoption of new reporting tools that linked to existing country data systems. They held regular meetings to review data, discuss any mistakes, and correct them. Over time, healthcare workers became more confident in documenting medication use, and the perceived burden of documentation decreased as they adapted. While health workers initially found the additional paperwork burdensome, they noted that regular measurement showed a decline in PPH cases after HSC was introduced, an increase in PPH case detection after introducing calibrated drapes, and due to the new treatment protocols, they observed fewer referrals and fatalities. Overall, facilities showed a significant reduction in PPH cases and fewer referrals to higher-level care. 

Ongoing training and supervision strengthened the documentation process. Facilities now use registers and stock records to keep track of PPH medications and products and prevent errors. Thanks to these improved supplemental reporting tools facility managers have been able to ensure that essential drugs such as HSC and tranexamic acid and calibrated drapes for better detection (part of the MOTIVE treatment bundle) are consistently available. Project staff reflected that the regular monitoring of performance and decision-making using data coupled with continuous mentorship and sensitization, strengthened adherence to guidelines, converting data from administrative documentation into a powerful driver of quality improvement. 

Maternity healthcare workers and facility managers who participated in key informant interviews conducted 6 and 15 months after the introduction of the new PPH protocol and products at AMPLI-PPHI sites described the benefits of improved measurement. In Kenya, maternity health workers reported a significant drop in PPH cases—from “one or two cases per 15 deliveries to just one case over six months.” They praised HSC for its effectiveness, its ability to improve uterine contractions, and its lack of refrigeration requirements. Facility managers noted how these improvements have led to better health outcomes for mothers, with one stating, “Maternal deaths from PPH are unlikely now because we can spot bleeding early and react quickly.” Additionally, focusing on measurement has made everyone more accountable. As one manager noted, “Our documentation is now clearer, allowing quality improvement committees to track cases more effectively.” 

Enhancing Routine National Level Measurement 

While supplementary registers and data collection tools are valuable tools when there is project support for their implementation, they are not practical to maintain at a larger scale. Health Management Information Systems (HMIS) metrics are essential for measuring and assessing quality of care, supporting procurement and financing efforts, and tracking progress, especially for new interventions. At the same time, updating national indicators has a systems-wide impact and is time-consuming.  

At the national level, actions taken by AMPLI-PPHI to integrate important metrics included working with the MOH to advocate for the inclusion of new prevention and treatment indicators and blood loss measurement tools into the maternity registers and HMIS summary. Project teams engaged MOH counterparts in co-creating supplemental data reporting tools, in the data reporting and review process, and in advocacy efforts to include new metrics in the national data system throughout project implementation. 

Conclusion 

It’s clear that metrics and measuring the implementation and effectiveness of these life-saving interventions is essential to improving maternal health worldwide. HMIS serve all areas of health and cannot work in isolation. Measuring new interventions to demonstrate impact is essential to scale. Integrating new metrics into routine data systems requires advocacy and systems thinking and provides the evidence decision-makers need to scale a life-saving intervention.