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The millennium development goals (MDGs) were designed to realign national priorities towards human development of which healthcare is the foundation. An extension of the MDGs, the sustainable development goals (SDGs), has more recently been introduced and has become the core focus for Sub-Saharan Africa (SSA) regardless of her performance vis-à-vis the MDGs. A transition into accomplishing the SDGs without identifying the efficiency and determinants of the shortfall in achieving the MDGs is a flawed approach. This paper seeks to estimate the efficiency of healthcare systems in SSA based on health focused MDGs. We estimate the technical efficiency and total factor productivity of these systems, and rank the annual performance of SSA’s healthcare systems from 2010 to 2015 using a robust data envelopment analysis (DEA) approach. Regression analysis is applied to the determinants of healthcare system efficiency. The DEA results show healthcare systems in SSA to be inefficient, with only three countries; Botswana in 2015, Rwanda in 2014 and 2015, and Tanzania in 2015; identified as efficient over the evaluated period. Failure to achieve technological advancements is the identified leading cause of a decrease in productivity. Scale inefficiency is determined to be the primary cause of technical inefficiency. The study also shows that governance measures, i.e., the rule of law and government efficacy, impact healthcare system efficiency more than public expenditure on health, indicating that the volume of resources invested in healthcare systems is not as important as the efficient management of the said resources in SSA countries.
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