<p>&nbsp;</p><p><strong>Background:</strong> Maternal and perinatal death surveillance and response (MPDSR) is essential for enhancing maternal and new-born healthcare outcomes. While Ethiopia has implemented MPDSR systems, their effectiveness at the district level remains underexplored. This study evaluates the performance of the MPDSR system, focusing on core activities, supportive functions, and system attributes in the Misrak Belessa district, Northwest Ethiopia.&nbsp;</p>