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This paper analyzes the structure of basic sanitation service provision in Brazil and the institutional framework, seeking to identify the main factors that limit the expansion of services, the resumption of investment and increased efficiency, in an attempt to find possible solutions to overcome the problems of the sanitation sector, for example, greater private participation and/or ways of increasing efficiency in public provision. It also seeks to present possible actions and measures to clean up the sector, as well as the needs it requires to universalize water supply and expand sewage collection and treatment in the country. Based on the SNIS, it was possible to analyze the performance of basic sanitation service providers in southeastern Brazil (public and private), checking what the trend is for each group of providers. Some private and public management experiences were also selected, as well as a case of a public company.