This paper analyzes municipal solid waste management (MSWM) performance across all 2,887 municipalities in Slovakia, introducing a novel approach to estimate composite efficiency indicators that incorporate EU and Slovakia waste targets into an efficiency assessment model. The analysis covers data from 2017 to 2021 and is conducted in 2 stages. In the first stage, technical efficiency and Malmquist indices are estimated using DEA AR-I models, where waste targets are converted into output weights. The results indicate significant improvements in MSWM performance over the analyzed period, with an overall performance improvement in MSWM expressed by an average Malmquist productivity index of 76.4%, primarily driven by a technical efficiency improvement of 89.4%. The second stage examines the impact of external factors on MSWM efficiency. Findings reveal statistically significant differences in MSWM efficiency between municipalities with and without access to incineration technology, favoring those with access. Among the 3 pricing methods for waste collection, volume-based pricing outperforms alternative methods. Among 10 municipality size classes, the highest efficiency scores are achieved by municipalities with over 100,000 inhabitants. Furthermore, the research indicates variations in MSWM efficiency across 8 distinct regions of Slovakia, suggesting a considerable influence of region-specific MSWM programs. Additionally, a positive correlation is identified between the education level of the municipal population and MSWM performance. These findings, along with the methodology that considers waste targets, provide a substantial theoretical framework for assessing, formulating, and executing future governmental strategies and policies aimed at enhancing the efficiency and sustainability of MSWM in Slovakia.