Objective To analyze implementation of the maternal and neonatal death surveillance and response (MNDSR) strategy in Burundi. Methods Secondary data analysis using a qualitative approach and document review. The qualitative approach consisted of semistructured interviews with decision‐makers at central, regional, and district levels, health providers, and technical and financial partners using four interview guides and a data extraction tool. Document review utilized maternal death review reports and policy documents. Interviews and hospital visits took place from July 16–26, 2017, in Bujumbura and Gitega, Burundi. Results Notification of maternal deaths is incorporated into the Integrated Disease Surveillance and Response (IDSR) system. Maternal death review committees existed in the five visited hospitals (Prince Regent Charles Hospital and Kamenge University Hospital in Bujumbura, Gitega Regional Hospital, Kibimba District Hospital, and Kibuye District Hospital) but not at subnational level (provincial or district levels). Since the beginning of 2017, maternal death review has been effective and regular in some district and regional hospitals due to integration of quality‐of‐care criteria for the performance‐based financing strategy; review has been less effective at national hospital level. Implementation of review recommendations is heterogeneous and varies from one health facility to another. No formal follow‐up mechanism on review recommendations was identified. Notification and review of neonatal deaths does not occur, nor does notification of maternal or neonatal deaths at community level. Conclusion Despite integration of notification of maternal deaths into IDSR, efforts must be undertaken to scale up MNDSR to include neonatal deaths and maternal and neonatal deaths at community level.