“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

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.