“It might be a statistic to me, but every death matters.”: An assessment of facility-level maternal and perinatal death surveillance and response systems in four sub-Saharan African countries

Maternal and perinatal death surveillance and response (MPDSR) systems aim to understand and address key contributors to maternal and perinatal deaths to prevent future deaths. From 2016–2017, the US Agency for International Development’s Maternal and Child Survival Program (MCSP) conducted an assessment of MPDSR implementation in Nigeria, Rwanda, Tanzania, and Zimbabwe. A cross-sectional, mixed-methods research design was used to assess MPDSR implementation. The study included a desk review, policy mapping, semi-structured interviews with 41 subnational stakeholders, observations, and interviews with key informants at 55 purposefully selected facilities. This study was the first to apply a standardised scoring methodology to assess subnational and facility-level MPDSR implementation progress. Structures and processes for implementing MPDSR existed in all four countries. Many implementation gaps were identified that can inform priorities and future research for strengthening MPDSR in low-capacity settings.