| Olá, *|NOME|* Brazil faces a serious situation of inequality in access to basic sanitation, with negative impacts especially on child health. To face this challenge, the New Sanitation Framework (Law 14.026/2020) established ambitious goals for municipalities by 2033: to ensure 99% coverage of water supply and 90% coverage of sanitary sewage. The framework brought institutional and regulatory changes to increase competition in contracts, promote greater transparency and reinforce legal certainty in concessions and privatizations. In this context, IMDS prepared the Technical Note "Basic Sanitation in Brazilian Municipalities: consequences for child health and Public Policy paths" (access here), which seeks to deepen the understanding of this problem and propose practical solutions. The analysis focuses on three main aspects in Brazilian capitals: the coverage of treated water and sewage services; the rate of hospitalization of children under 5 years of age for diseases related to inadequate sanitation, and the measures that can be taken to reverse this challenging scenario. The disparity in the provision of treated water supply and sanitary sewage in Brazil is worrisome, with large differences in coverage even between capitals. On average, Brazilian municipalities have 59% of their inhabitants covered by sanitary sewage. The calculation of the average Brazilian city is determined by the arithmetic average of the municipalities with available data. Regional differences are also quite pronounced. The municipalities in the Southeast have on average 72.25% of the households covered by access to sanitary infrastructure. In the North, this percentage is only 27.80%. The municipal averages of the Midwest, South and Northeast regions are, respectively, 51.65%, 50.30% and 36.64%. In 2022, sanitary sewage coverage varied widely among Brazilian capitals, ranging from 100% in cities such as Curitiba (PR) and Belo Horizonte (MG) to less than 10% in places such as Macapá (AP) and Porto Velho (RO). The North and Northeast regions are the ones with the lowest sewage coverage: only 27.8% and 36.64%, respectively. These regions also face financial difficulties in meeting the goals of the new framework, requiring specific solutions and greater allocation of resources. Data from 2023 show that the country recorded an average of 300 hospitalizations for every 100 thousand children aged 0 to 4 years due to diseases related to inadequate sanitation. Some capitals, such as Belém (PA) and Brasília (DF), surpassed the mark of 800 hospitalizations per 100 thousand children, highlighting the urgency of corrective measures. In the case of Belém, sanitation coverage in 2022, despite having expanded coverage, did not reach 20% of the population in 2022. The municipality went from 4053.72 hospitalized children for every 100 thousand inhabitants in 2016 to 849.36 in 2022. To analyze the coverage of basic sanitation services, the Technical Note used the IMDS Municipal Elections Panel (see here), built from data from the National Sanitation Information System (NSIS). The main source of evidence on successful public policies that the study uses is the Impact Platform (access here), a tool that serves as a digital "encyclopedia" of IMDS’s, and documents impact evaluations of programs that affect the development of children and young people and the formation of human capital. The situation of the availability of treated water is a little better, but the North region still presents disturbing rates, with an average coverage of only 60.05%. The average Brazilian municipality has 77% of its inhabitants with water supply, while most Brazilian capitals have reached the mark of 90% of the population covered, including all capitals in the Southeast, South and Midwest. However, regional disparities still persist; while the municipalities in the South guarantee this service to 78.50% of the inhabitants, those in the Northeast have an average of 64.80%. This inequality in the distribution of treated water directly reflects public health conditions, especially in regions with lower coverage.
In the Integrated Development Region of the Federal District and Surroundings, for example, despite the good rates of water and sewage coverage in Brasília, the precarious conditions in neighboring municipalities aggravate the rates of hospitalizations for diseases related to inadequate basic sanitation. In 2022, the average coverage of sanitary sewage in this region was 58.9%, and treated water, 76.8%. This situation highlights how the lack of universal access to sanitation directly impacts health: the lower the coverage rates, the higher the frequency of hospitalizations for diseases associated with precarious sanitary conditions. Studies show that the complementarity between water and sewage services is fundamental. When they are implemented simultaneously, the positive impacts on children's health are amplified, significantly reducing gastrointestinal diseases. Finally, the Technical Note discusses public policy paths to change this reality. International cases reinforce the importance of integrated policies in sanitation. In Mexico, the Agua Limpia program (1991) expanded access to treated water from 58% to 90% in just six months, reducing infant mortality by up to 13% and deaths from diarrhea by up to 67%, especially in areas with adequate sewage. In Boston, in the United States, between 1892 and 1904, the expansion of the sewage network reduced infant mortality by 31% for children under 1 year of age and by 26% for children from 1 to 5 years of age, showing the benefits of simultaneous improvements in services. In Brazil, it is crucial to adopt integrated approaches to implement water and sewage services jointly, considering regional specificities. The New Sanitation Framework represents an opportunity for transformation, but it requires the acceleration of actions, the proper allocation of resources and the guarantee that no region is left behind. See you in the next "IMDS Letter"! Paulo Tafner CEO |
