Using the CDC updated guideline for surveillance system evaluation, a structured questionnaire and checklist were used to collect data from registers, patient folders and interviews. We recruited 25 stakeholders involved in the maternal mortality surveillance system at different regions and levels of health care delivery in The Gambia. Observations, record review were also conducted. Epi info version 7 was used to analyze the data. Maternal Death Surveillance System attributes indicators evaluated were graded as “1” when appropriately answered and scores “0” for findings that do not support attribute. Sum of scores for each attribute was divided by total number of questions and multiplied by 100%. Scores were graded as excellent (90-100%), good (70-89%), fair (50-69%) and poor &amp;lt;50%. 