<![CDATA[Technical efficiency is essential for improving maternal and child health (MCH) outcomes by ensuring the optimal use of limited public health resources. This study evaluates the technical efficiency of MCH services across 38 districts and municipalities in East Java Province during 2015–2019 using a two-stage Data Envelopment Analysis (DEA). An output-oriented Variable Returns to Scale (VRS) DEA model estimates efficiency scores, while Tobit regression examines the effects of environmental factors, including access to safe drinking water, healthy food processing facilities, and healthy public places. The results reveal substantial variation in efficiency, with only a few local governments consistently operating on the efficiency frontier. Exclusive breastfeeding coverage, neonatal care, and skilled birth attendance are identified as the main sources of inefficiency. Environmental factors show mixed effects, suggesting that they support but do not solely determine service efficiency. This study extends the public health efficiency literature by integrating operational MCH service indicators with environmental determinants in a decentralized health system. The findings provide practical insights for improving MCH service delivery through more efficient resource allocation, cross-sectoral collaboration, and context-sensitive public health policies.]]>
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