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High maternal deaths (MD) is one of the poor health indicators prevalent in developing countries. The underlying causes of the MD are greatly associated with factors that are embedded in the communities and health care delivery system. Studies have touted maternal death audits (MDA) to be one of the strategies to curb the needless loss of maternal life during perinatal period. However, much has not been done to examine the specifics on how health facilities establish and operationalize MDA systems. The study revealed the key issues affecting MDA, namely; no orientation done to persons appointed into the MDA committee, lack of a comprehensive mechanism to disseminate MDA findings to various stakeholders, no monitoring and evaluation system to track progress made on MDA, and no incentives given to MDA committee members. Results indicate that, as narrated by the study participants, instituting a robust MDA mechanism would ensure that the audits generate credible information that health systems would use to improve maternal health services in order to reduce the high MD.