Efficiency of maternal, newborn, and child services in achieving Sustainable Development Goals 3.1 and 3.2 in Africa: a two-stage data envelopment analysis

Africa remains well short of achieving Sustainable Development Goals 3.1 and 3.2, yet evidence on how efficiently health systems transform resources into maternal, newborn, and child health (MNCH) outcomes remains scarce. This study evaluates MNCH service efficiency across 46 African countries and investigates its determinants. Using World Health Organization data for 2005–2021, we applied a two-stage framework. First, input-oriented data envelopment analysis under constant and variable returns to scale estimated technical efficiency and identified benchmark countries. Second, Tobit regression assessed the financial, coverage, governance, and health-system factors associated with efficiency. Only 12 countries operated on the efficiency frontier; thus, 74% performed below best-practice levels. Mean variable-returns-to-scale efficiency was 0.849, implying that inefficient systems could theoretically reduce inputs by approximately 15% without compromising comparable outputs. Eritrea, Seychelles, and São Tomé were key benchmarks. Health gaps persisted: maternal mortality averaged 354.2 deaths per 100,000 live births, while neonatal mortality reached 23.5 per 1,000, substantially exceeding the SDG targets of 70 and 12. The preferred Tobit model displayed strong explanatory power (pseudo-R² = 0.8943). Current health expenditure, the composite coverage index, and current health expenditure per capita were negatively associated with efficiency, indicating that greater spending or coverage does not automatically produce better resource conversion. Achieving the MNCH-related SDGs therefore requires more than increased investment: African health systems must strengthen accountability, optimise resource allocation, target workforce and infrastructure gaps, and adapt practices from efficient peers. These findings offer a continent-wide evidence base for context-sensitive reforms focused on efficiency, equity, and measurable health gains.