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The negative influence of professional hierarchies between health cadres can silence nurse-midwives and junior medical staff,6 and may even demotivate personnel from participating in MPDSR. Maternal and perinatal death surveillance and response (MPDSR) is a health systems process entailing the continuous cycle of identification, notification and review of maternal and perinatal deaths (Surveillance), followed by actions to improve service delivery and quality of care (Response).1 Before the coronavirus disease 2019 (COVID-19) pandemic, there were an estimated 4.6 million maternal and neonatal deaths and stillbirths each year.2 During the pandemic, maternal and perinatal health outcomes have worsened, especially in low- and middle-income countries,3 highlighting the urgent need to galvanise MPDSR to end preventable mortality and strengthen health systems. Overcoming the blame culture that currently impedes MPDSR implementation requires action at all levels of the health system. 1 Therefore, dual national prioritisation on the value of systems learning and quality improvement that MPDSR encompasses needs to be matched with political priority for health system investment to implement I response i , deliver improved health outcomes and reduce the number of preventable deaths. [Extracted from the article]