Tracking and appraising maternal and perinatal death surveillance and response implementation in Nigeria: a historical timeline and policy analysis

Abstract Background Nigeria bears one of the highest global burdens of maternal and perinatal mortality, despite decades of global and national efforts to address preventable deaths. Maternal and Perinatal Death Surveillance and Response (MPDSR) is a key strategy to reduce preventable deaths. This study synthesises the historical trajectory and policy evolution of MPDSR in Nigeria, examining factors shaping its uptake, scope, and institutionalisation. Methods We conducted a historical timeline and policy analysis using systematic review principles. Peer-reviewed and grey literature were retrieved through comprehensive database and web searches, complemented by stakeholder engagement. Data were extracted from 24 eligible documents and analysed using Walt and Gilson’s policy triangle framework to explore policy content, context, actors, and processes over time. Results Four phases of MPDSR implementation were identified, showing a shift from facility-based maternal death reviews to broader inclusion of perinatal and community components. Federal policymakers and professional associations have driven national-level adoption, while state-level uptake varies depending on political will and capacity. Community and facility-based MPDSR have evolved as fragmented practices rather than an integrated system. Facility-level implementation is comparatively more established, while community-based MPDSR remain limited, donor-driven, and inconsistently integrated. Progress towards institutionalisation is hampered by weak legal frameworks and insufficient subnational capacity. Persistent challenges faced by frontline workers and variable community engagement further undermine MPDSR sustainability. Conclusion To maximise the potential of MPDSR as a tool for accountability and system strengthening, Nigeria must integrate community and facility-based surveillance within a unified system, backed by legislation, sustained financing, and capacity building.