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In the post-conflict context of the Central African Republic, underreporting of maternal deaths in health facilities has occurred. There are no guidelines in place for operational or intermediate levels. There are no review or audit committees within the health facilities, districts, or regions, or at the national level. Only three hospitals have an informal review committee. Implementing the MDSR system is not an easy task, especially in Africa, which has surveillance systems that remain fragile and inefficient. Conflict situations have affected the system, and the lack of optimal funding does not enable ideal implementation of these intervention strategies. [ABSTRACT FROM AUTHOR]