Benchmarking the performance of healthcare systems in the provision of childhood immunization services in sub-Saharan Africa from 2016 to 2019

Childhood immunization rates in many sub-Saharan African (SSA) countries have stagnated, trailing behind other global regions. This study evaluates the efficiency of childhood immunization service delivery and its environmental determinants in 36 SSA countries from 2016 to 2019. We apply data envelopment analysis (DEA) to measure technical efficiency, truncated bootstrap regression to assess influencing factors, and the Malmquist productivity index (MPI) to track productivity changes over time. Findings show that 36% of SSA countries have not met the World Health Organization’s 90% immunization target. The bias-corrected technical efficiency of immunization services is 0.895 (95% CI: 0.878–0.912). However, an MPI value of 0.715 indicates a 28.5% decline in total factor productivity, mainly due to slow technological advancements. Efficiency is positively associated with female education, governance quality, social health insurance coverage, population density, and healthcare access, while per capita GDP negatively correlates with efficiency. Despite high efficiency in some SSA countries, productivity remains hindered by technological limitations. We recommend that governments and international partners prioritize investments in technology and healthcare infrastructure to enhance productivity and improve immunization coverage.