Social, institutional and political dynamics of reporting maternal deaths in multiple systems in Tanzania

Background Accurate and timely data are critical for addressing maternal morbidities and deaths in low- and middle-income countries. In Tanzania, three parallel systems; the Maternal and Perinatal Death Surveillance and Response (MPDSR), the Registration Insolvency and Trusteeship Agency (RITA), and the District Health Information System (DHIS2), are used to report maternal deaths. However, settings with uncoordinated systems have reported inefficiencies, redundancies, and inconsistencies. This study aimed to explore user experiences with maternal death reporting across the reporting systems to identify strengths, weaknesses, and opportunities for integration. Methods A mixed-methods approach was employed, including key informant interviews (KIIs), a focus group discussion (FGD), and secondary analysis of maternal mortality data from 2020 to 2022. Participants included healthcare providers, health managers, and government officials at various administrative levels involved in maternal deaths reporting. Qualitative data from the KIIs and the FGD were analysed thematically using Braun and Clarke’s approach. Quantitative data was descriptively analysed and compared across systems. Results All three reporting systems are government-managed and utilize standard international tools. Participants described reporting demands as burdensome, with overlapping responsibilities leading to redundancy and data inconsistencies. Reporting is largely manual at the facility level, resulting in delays and data loss. Political pressure to report maternal death figures, including instances of interference, further exacerbated challenges. Quantitative data revealed a substantial difference in reporting of maternal deaths across systems and underreporting relative to national estimates. Participants advocated for system integration, improved coordination, and digitalization, particularly leveraging DHIS2, to streamline processes, save time and improve data quality. Conclusions Current fragmented and manual reporting systems create redundancies and delays that hinder effective maternal deaths surveillance in Tanzania. A coordinated integration and digitalization strategy is urgently needed to improve data quality, reduce inefficiency and redundancy and support evidence-based decision-making in maternal health. Further research should focus on feasible models for system integration and implementation.