With growing environmental legislation and growing public awareness of the importance of pursuing sustainable growth, developed nations are increasingly recognizng the value of waste reduction, recycling, and reuse maximisation. MSWM efficiency is the focus of this study, which also attempts to identify the most effective ways to put MSWM policies into practice and make significant strides in increasing MSWM efficiency. This empirical study examines the ecological and economic performance of MSWM for 26 major cities of Madhya Pradesh state, India in 2016 to 2020. A non-parametric approach, Data Envelopment Analysis (DEA) method has been employed. More precisely, output-oriented DEA models have been used to analyse both constant and variable returns to scale in the context of environmental performance. The results from the DEA CRS model indicate that 12 units were efficient in 2016-2017, 10 units in 2017-2018, 13 units in 2018-2019, and 16 units in 2019-2020. In contrast, the DEA VRS model predicts that the number of efficient units were from 16 in 2016-17 to 14 in 2017-18 to 17 in 2018-19 and 19 in 2019-2020. Additionally, the Shapiro-Wilk normality test shows that the distribution of efficiency scores is not normal. Out of the 26 units analysed, 15 have an efficiency score of 1, indicating they are technically efficient. The mean efficiency score for all units is 0.959, with 57.7% of units having an efficiency score of 1. Only 3.8% of units have an efficiency score between 0.7 and 0.8. The study finds that the Northern and Central large cities have higher efficiencies compared to the Eastern and Southern regions. Cities in the north, centre, and south had Potentially Toxic Elements (PTEs) that were comparatively less. The PTE of western cities was comparably more, while the eastern region’s efficiency distribution was dispersed.