Achieving universal access to safe sanitation is a challenge that requires the integration of public policies, investment, technology, and efficient sewage waste treatment. This study examines sewage waste management in Brazil from a sustainable development perspective, assessing the availability of resources, actions, treatment types, disposal methods, treatment efficiency, and potential reuse opportunities. Historical data from 5570 Brazilian municipalities were compiled from key national sanitation databases. The analysis combines descriptive statistics, exploratory factor analysis, and qualitative assessments of the Sustainable Development Goal (SDG) 6 targets. The findings reveal that Brazilian sewage programs primarily emphasize population coverage while neglecting technical and qualitative aspects of sewage treatment. Water potability remains below SDG target 6.1, and if current investment patterns persist, Brazil will not meet target 6.2 by 2030, leaving only 42 % of the population with access to sewage services. Analysis of target 6.a highlights issues with insufficient local policies and limited financial investment. The development of the Sewage Treatment Index (STI) enabled a comprehensive assessment of treatment efficiency across all 5570 municipalities, highlighting areas for improvement and opportunities for sustainable practices. The results showed that only 33 % of municipalities met satisfactory sewage treatment efficiency (target 6.3). Although still in its early stages, incipient efforts toward sustainable sewage management are emerging through the regulated reuse of sewage waste in 1 % of municipalities, offering promising environmental, social, and economic potential benefits. However, the lack of regular census and sanitation survey data hinders transparent monitoring of progress toward SDG goals and national requirements. These findings raise questions about the accuracy of SDG 6 monitoring globally, suggesting that other countries may also be further from achieving the targets than current reports suggest.
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