Objective: This study evaluates the impact of maternal and infant mortality on healthcare system efficiency in Sub-Saharan Africa (SSA) using a directional Data Envelopment Analysis (DEA) model.

Method: The analysis incorporates desirable outputs, such as healthcare coverage, and undesirable outputs, specifically maternal and infant mortality rates, to assess the relative efficiency of 36 SSA countries over 12 years (2006–2017).

Findings: Findings reveal that healthcare expenditure significantly influences efficiency, accounting for over 50% of the variation in performance scores, followed by the availability of nurses and midwives. Countries with lower maternal and infant mortality rates consistently ranked higher in efficiency, highlighting the dual role of mortality as both an outcome and a determinant of health system performance. Sensitivity analysis further confirmed that strategic investments in workforce and financing yield substantial efficiency gains.

Conclusion: The study offers empirical evidence supporting the integration of mortality indicators into performance assessments and presents a robust methodological framework for evaluating health systems in resource-constrained settings. It contributes to the literature by addressing methodological gaps and providing actionable insights for policymakers. The results underscore the urgency of prioritizing maternal and child health in healthcare reform agendas to achieve equity and efficiency across SSA.

Maternal Mortality, Infant Mortality, Healthcare Efficiency, Data Envelopment Analysis, Sub-Saharan Africa

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