In 2015 over 2,060,000 babies were born in Tanzania but 38,600 of these newborns died in their first month of life. In addition, there were nearly 47,100 stillbirths and 8,200 maternal deaths (UNICEF 2016). According to WHO & UNICEF (2019), the maternal mortality ratio in Tanzania is 524 deaths/100,000 live births over the past decade. The United Nations’ Sustainable Development Goals (SDGs) include reducing the global maternal mortality rate to less than 70/100,000 live births by 2030. Maternal and perinatal death surveillance and response is widely recommended as an intervention to reduce maternal and perinatal mortality and to improve quality of care and could be key to attaining SDGs. Given this context, efforts to eliminate preventable maternal and newborn deaths in Tanzania need to include strong accountability processes, such as the MPDSR, that contribute to improving the quality of maternal and newborn health care and identifying challenges leading to maternal and newborn deaths head-on.