Introduction: Maternal and Perinatal Death Surveillance and Response still poses serious challenges in the DRC and in the Kasai province. The objective of this study was to evaluate its performance, identify gaps, and propose appropriate solutions to contribute to reducing maternal and perinatal mortality in the province. Methods: This was a mixed-methods study with a comprehensive design (cross-sectional analytical for quantitative data, phenomenological for qualitative data) covering the period from January 1, 2022, to December 31, 2024. Quantitative data were analyzed using Epi Info (v7.2.6.0) with descriptive and inferential statistics (95% CI). Qualitative data were analyzed thematically. Results: The performance of the system’s pillars ranged from 19% to 56%. Only 25% of deaths were reviewed in the province during the evaluation period. Providers trained in maternal and perinatal mortality monitoring (MPM), the availability of MPM forms, the existence of an MPM committee in the health district (HD), the completion of maternal and perinatal death reviews, and the holding of HD MPM meetings are associated with the performance of the MPM system (p < 0.05). Conclusion: The MPM system remains underperforming in Kasai Province. To strengthen its performance, it is important to address its core components by strengthening infrastructure, financial management, and communication; and to build the capacity of MPM and HZN providers and foster their retention.
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