Economic Benefits of Expanding the Brazilian Sanitation

ECONOMIC BENEFITS OF EXPANDING THE BRAZILIAN SANITATION

QUALITY OF LIFE, PRODUCTIVITY, EDUCATION AND ENVIRONMENTAL APPRECIATION Contents

Introduction

Sanitation in the World

Sanitation in Brazil

Highlights

Sanitation and Quality of Life

Sanitation and Productivity

Sanitation and Education

Sanitation and Environmental Appreciation

2 Introduction

A country that aspires to stand out on the This work promotes for the first time an international scene as developed cannot be international comparison and shows that Brazil, among the most underdeveloped nations on the the world’s 7th biggest economy, is the 112th in most basic issue - sanitation. 21st century Brazil, the sanitation ranking. It also shows that the 4.1% host of the 2014 World Cup and the 2016 Summer yearly sanitation expansion rate decreased in Olympics, is not capable of providing treated water, the 2010s - in the previous decade it was 4.6% – sewage collection and treat-ment to all its citizens. what puts Brazil even farther from the already far goal established by the national government to According to data from the Ministry of Cities offer universal access to these services by 2030. (the 2011 National System of Sanitation Indexes, SNIS in Portuguese) about 36 million Brazilians However, the worrying data should not prevent do not have access to treated water yet, only people from seeing the opportunities of 48.1% of the population have access to sewage considerable gains generated by the choice of collection, and of what is collected, less than making a public policy priority of offering universal 40% is treated. These numbers are reflected in access to treated water and sewage, which can the pollution of water resources and in diseases be planned and executed through partnerships during infancy and childhood that put Brazil between governments, companies, academy and far from any comparison with European, North the society. From this prioritization, to be signalized American and even some South American countries. by the government, there will be improvements in health, education, job creation and income, Besides compromising people’s health and quality productivity, real estate appreciation and tourism. of life, pollution also re-duces and makes water more expensive, harming agriculture, commerce, We are confident that the results highlighted industry, and tourism, among other sectors of in this work will offer a clearer view of the the economy. The lack of sanitation is one of opportunities generated by solving this challenge, the main reasons for employees absent from and, this way, incentivize governments and work, for students’ learning difficul-ties, for the companies to invest in sanitation in order to hospitalization of workers and their relatives, and make the reality of the Brazilian infrastructure also the com-munities around production units. adequate to the size and importance of Brazil.

Being aware of these impacts, but especially of the opportunities arising from investments in basic sanitation, the Trata Brasil Institute and CEBDS (Brazilian Business Council for Sustainable Development) joined forces to carry out the study “Economic Benefits of Expanding the Brazilian Sanitation”, which is hereinafter presented.

Édison Carlos Marina Grossi Executive President CEO Instituto Trata Brasil CEBDS

3 Opção 4: Dias 07, 08, 09, 10, 11, 14 e 15 de julho de 2014 (Manhã)

Sanitation in the World

Sanitation 112th place in the international ranking and Human In the most recent international comparative data, Brazil is in Development the 112th position in a ranking of 200 countries. This position is, beyond the shadow of a doubt, shameful for a country that is the Internationally, Brazil has a large gap regarding sanitation 7th biggest economy in the world. Brazil’s score in the Sanitation issues. Not only treated water but also sewage collection and Development Index – a number that takes into consideration treatment are very far from being universally accessible, which the current sanitation coverage and its recent development – causes losses to the quality of life and the economy. And since was 0.581 in 2011. This index is calculated similarly to the HDI, the Brazilian situation is especially deficient regarding access from the United Nations Development Programme (UNDP), to the sewage collection system, the environmental impact and takes into consideration the percentage of population is too high, what diminishes the value of the real estate and that has access to sanitation services in a given year and the the economic potential of activities that depend on good increase of this services coverage between 2000 and 2011. environmental conditions to be fully executed. The Brazilian index is below North American and European averages. But Brazil is not only behind the richest countries, whose sanitation development was consolidated throughout 112ª Colocação na classificação the centuries, but also behind patterns registered in North Africa and Middle East, which are ancient populations but internacional de Saneamento with average incomes lower than Brazil’s. Ecuador (0.719), Chile (0.707), Honduras (0.686) and Argentina (0.667) also have indexes that are much higher than Brazil’s in 2011. For all those countries, the scores are better not only because they have SANITATION DEVELOPMENT INDEX, better coverage levels, but especially because the expansion THE CLOSER TO 1 THE BETTER rate of the sanitation coverage is faster. This means that Brazil, regardless of its recent developments, is still distancing itself from this group of countries regarding sanitation development.

1 Data related to 2011. Repercussions on development

North America Germany 0.642 Asia Europe (Western 0.504 0.640 and Eastern) 0.582 Middle East 0.576 Central America 0.636 North 0.563 Africa 0.227 Sub-Saharan Brazil 0.581 Africa 0.542 0.594 South Oceania America

World Development Indicators and Atlas do Desenvolvimento Humano no Brasil de Brazil is in the 112th position in the 200-country international ranking

4 The precarious situation of sanitation is also reflected in the Repercussions on development population’s longevity. The 73.3 years life expectancy in Brazil in 2011 was lower than Latin America’s average (74.4 years). Compared to geographically closer countries, Brazil is far The sanitation issue has immediate repercussions on health behind Argentina (75.8 years) and Chile (79.3 years). indexes. In Brazil, the infant mortality rate was 12.9 deaths for every 1,000 infants born alive in 2011. This number is much The effects on the economy are evident. Tourism, an activity higher than the world’s average or infant mortality rate in Cuba that depends on good environmental conditions to grow, (4.3‰), Chile (7.8‰) or Costa Rica (8.6‰). The graph below suffers with the lack of sanitation. Those Latin American shows the relation between infant mortality rate and access economies that perform better on sanitation issues have fairly to sanitation for the group of countries analyzed in 2011. It larger international touristic influxes. Cuba, Chile and Argentina is clear that the larger the access to sanitation, the lower the received 238, 176 and 139 foreign tourists respectively for every infant mortality. one thousand habitants in 2011. In Brazil, this number was only 27 tourists for every one thousand habitants in the same year.

For those reasons, the level of sanitation development ends 140.0 up being clearly reflected on countries’ human development. As illustrated on Graph 1.2, the 120.0 access to sanitation is positively correlated to the Human Development Index by UNDP. 100.0 Countries with high indexes of access to sanitation (greater 80.0 than 0.650) also have high HDI (greater than 0.750).

60.0

40.0

20.0 Mortalidade (mortos infantil por mil nascidos vivios) Infant mortality births) per thousand live (deaths 0.0 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 Access to Sanitation Index Índice de acesso ao saneamento Brazil

1.0

0.9

0.8

0.7

0.6

0.5 Índice de Desenvolvimento Humano 0.4

0.3 Human Development Index Human Development

0.2 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 Access to Sanitation Index Índice de acesso ao saneamento Brazil

5 Sanitation in Brazil Sanitation deficit and its impacts in the country Brazil’s lag in sanitation issues has a historical background. 50 years ago only one in every three dwellings was connected to the sewage collection or to the river network. This means that Slow growth only 1/3 of the population had sewage taken far from where they lived. Regarding sewage treatment the situation was even worse: not even 5% of the sewage collected received any Data from the last decade lead to apprehension. The growth treatment before being disposed in the environment. During rate regarding the level of access, of 4.1% per year, was below the last decades the situation improved, although in a very the historical average of 4.6% per year. slow pace. In 2010, the number of dwellings with bathrooms connected to the sewage collection or rainwater systems Generally, in the last decade the growth rate was higher on reached 31.5 million, according to data from IBGE ’s census. states with less access to sanitation services. For instance, The portion of dwellings covered by this system reached 55%, some states in the North region had a faster growth. Tocantins and it is worth highlighting we can not consider connecting had the highest: almost 21% per year between 2000 and 2010, sewage to the rainwater system a correct option, even resulting from great government investments. though IBGE takes this into consideration in its calculations. Dwellings with and without access to the sewage*, in millions The South region, which also lacks basic sanitation, was driven 70 by growth on states with higher deficits: Rio Grande do Sul and Santa Catarina, both with rates higher than 7% per year. 60 On the other hand, states where the access to sanitation is 26.9 50 already widespread, such as São Paulo, Minas Gerais and Rio de 25.8 Janeiro, still have 3.1 million dwellings without access to treated 40 water and 8.2 million without sewage collection, according to 24.3 data from the National System of Sanitation Indexes – SNIS. 30 22.7 20 18.8 35.8 15.3 31.5 10 11.7 21.2 7.9 6.7 11.6 6.5 0 1.2 3.3 1.8 2.3 Table of indexes for each Federal Units 1940 1950 1960 1970 1980 1990* 2000 2010 2012** SNIS 2011 Sanitation deficit Index of access to the Index of access to Index of sewage Index of losses in States Dwellings with access water system sewage system treatment distribution Total Total Total Urban Sewage sewage population population population population collected generated % % % % % % % INO55 INO23 INO56 INO24 INO16 INO46 INO49 Rondônia 41.7 54.8 3.7 5 55 4.1 53.8 Acre 62.6 83.1 20.1 22.2 100 34 64.7 Amazonas 79.6 91.9 26.5 27.2 96.2 22.3 49.7 Roraima 80.8 99.6 18.5 24.2 100 19.7 58.1 Pará 42 53.9 3.3 4.3 40.8 1.5 42.3 Amapá 37.6 41.7 4.2 4.7 92.9 11.3 73.3 Tocantins 73.3 91.4 13.5 17.2 99.9 15.8 34.6 North Region 55.5 69 9.6 11.8 90.6 12.7 49.7 Maranhão 50.4 73.6 10.5 16.2 24.2 7.8 55.9 Piauí 64.9 92.9 5.9 8.5 94.6 9.6 59.1 Ceará 72.9 93.1 28.2 3.7 94.4 33 35.3 Rio Grande do Norte 75 93.3 19.9 25.3 79.9 28.6 57.4 Paraíba 71.1 92.4 25.6 33.5 96.9 31.4 45.9 Pernambuco 68.8 83 15.6 19.2 91.4 26.2 65.7 Alagoas 73.4 88.3 16.6 21.8 89.4 26.8 59.6 Sergipe 81.6 92.7 15 19.9 91.8 21.3 60.3 Bahia 78.6 94.7 29.5 39.6 89.1 42.9 38.2 Northeast Region 71.2 89.4 21.3 28.4 84.3 30.1 51.4 Minas Gerais 86.6 99.4 65.5 75.5 43.4 28.2 33.1 Espírito Santo 84.6 97.7 40.5 47.3 70.3 27.4 34.6 Rio de Janeiro 88.2 89.4 59.3 61.2 63.8 35.5 32.8 São Paulo 95.7 98.5 86.7 89.8 66.9 48.1 35.2 Southeast Region 91.5 96.7 73.8 78.8 62.1 41.2 34.3 Paraná 89.6 99.8 56.1 65.4 98.5 61.4 33.1 Santa Catarina 86 97.1 17.8 21 98.5 21 33.6 Rio Grande do Sul 88.2 93.9 25.8 29.6 47.2 14.7 39 South Region 88.2 96.8 36.2 42 82.1 34.6 35.6 Mato Grosso do Sul 85.3 99.1 30.4 35.4 99.6 28.2 31.8 Mato Grosso 85.2 97.6 30.6 32.9 81.3 23.8 45.9 Goiás 83.8 92.4 38.9 42.8 86.3 43.6 31.6 Distrito Federal 99.5 99.5 93.7 97 100 65.6 24.8 Central-West Region 87.3 96 47.5 52 92.5 44 33.6 6 Total 82.4 93 48.1 55.5 68.8 37.5 38.8 Costs of universal access

The challenge for the future is enormous. The deficit of sanitation in Brazil reached a total of 14.3 million dwellings without access to treated water and 35.5 million without access to sewage collection. In 2012, there were 13.5 million dwellings without sewage collection in the Northeast region (37.9% of the national total). Taking into consideration the total of residences in the region, the deficit of sewage collection was of two in every three in the Northeast. The amount of resources necessary for that region, considering the distribution of treated water and sewage collection, is great. Using the SNIS’ database as reference, it is estimated that the universalization in the region would cost about R$ 75.9 billion. This is a bulky investment since it corresponds to 13.7% of the GDP in the Northeast region – the largest percentage among Brazilian regions. The amount of financial resources necessary to offer universal access to sanitation collection in Brazil adds up to R$ 313.2 billion, in values from 2013.

Dwellings without access to the general sewage system and costs of universal access, for each federal unit, 2011

Federal Dwellings without Dwellings without Costs of universal Percentage Unit access to water access to sewage access (in billion of GDP collection reais) North Region 2,704,207 4,379,744 31.434 14.1% Rondônia 329,168 483,575 3.588 12.9% Acre 116,357 185,892 1.340 15.2% Amazonas 428,681 874,331 5.850 9.1% Roraima 44,351 110,815 0.703 10.1% Pará 1,568,755 2,136,607 16.289 18.4% Amapá 128,651 182,156 1.369 15.3% Tocantins 88,244 406,368 2.294 12.7% Northeast Region 6,006,949 13,455,755 75.904 13.7% Maranhão 1,177.931 1,731.974 11.109 21.3% Piauí 369,801 889,003 4.925 20.0% Ceará 875,644 1,980.116 11.142 12.7% Rio Grande do Norte 260,653 812,808 4.247 11.8% Paraíba 383,067 948,149 5.216 14.7% Pernambuco 1,009.673 2,387,001 13.280 12.7% Alagoas 441,359 833,071 4.929 17.3% Sergipe 144,685 563,869 2.827 10.8% Bahia 1,344,136 3,309,764 18.229 11.4% Southeast Region 3,089,931 8,222,308 123.515 5.4% Minas Gerais 986,657 2,379,881 36.598 9.5% Espírito Santo 161,407 714,634 9.751 10.0% Rio de Janeiro 1,153,953 2,686,784 41.686 9.0% São Paulo 787,914 2,441,009 35.480 2.6% South Region 1,547,586 6,464,436 51.502 7.7% Paraná 485,160 1,720,481 14.097 5.9% Santa Catarina 426,078 1,936,859 15.231 9.0% Rio Grande do Sul 636,348 2,807,096 22.174 8.4% Central-West Region 998,552 2,962,400 30.808 7.8% Mato Grosso do Sul 213,106 671,712 6.899 14.0% Mato Grosso 450,214 881,366 10.164 14.2% Goiás 392,352 1,342,260 13.568 12.2% Distrito Federal (57,120) 67,062 0.178 0.1% Brazil 14,347,225 35,484,643 313.162 7.6%

Source: SNIS and IBGE (*) Universal access to sanitation and treated water (**) Average prices as in 2013. 7 Highlights

Sanitation in the world – Sanitation and Quality of Life Human Development

• According to the Ministry of Health (DataSus) more than • In the global context, Brazil is in the 112th position in a hospitalizations were notified due to gastro- sanitation raking of 200 countries. Brazil’s score in the 340 thousand intestinal infections in 2013 in the entire country. About Sanitation Development Index – a number that takes into 173 were classified by doctors as “diarrhea and gastro- consideration the current sanitation coverage and its recent thousand enteritis from presumable infection”. hospi- develop-ment – was 0.581 in 2011. The Brazilian index is 170.7 thousand talizations were of children and teenagers up to . below not only North American and European averages, 14 years old but also a few countries in North Africa and Middle East, • A s tudy shows that if no Brazilian had access to sewage countries with an average income lower than Brazil’s. Ecuador collection, cases of hospitalization due to (0.719), Chile (0.707), Honduras (0.686) and Argentina 400 thousand gastrointestinal infections would be expected in a year in the (0.667) had much higher indexes than Brazil’s in 2011. entire country. If 100% of the population had access to sewage collection this number would be reduced to about • The sanitation issue has immediate repercussions on health . indexes. In Brazil, the infant mortality rate was 12.9 266 thousand deaths for every 1,000 infants born alive in 2011, which is • In absolute terms, the number of hospitalizations should be much higher than the world’s average or the infant mortality reduced by cases, of these in the North- rate in Cuba (4.3‰), Chile (7.8‰) or Costa Rica (8.6‰). 74.6 thousand 56% east region. In relative terms, the North and Northeast would be the r egions with greater impact, whose number of in- • The precarious situation of sanitation is also reflected in the fections could be reduced by and respectively. population’s longevity. The 73.3 years life expectancy 31.0% 23.1% in Brazil in 2011 was lower than Latin America’s (74.4 years). • In 2013, the cost of a hospitalization due to gastrointestinal Compared to geographically closer countries, Brazil is infection in the Public Health System (SUS) was about far behind Argentina (75.8 years) and Chile (79.3 years). R$ 355.71 per patient, according to the national average. This caused a R$ 121 million public spending in 2013 alone, when the Northeast region was responsible for 52.1% and the North for 16.3% of this amount.

• The reduction from 340.2 thousand to 265.6 thousand cases in a year that could be accomplished with the universal access would save R$ 27.3 million each year, with 52.3% in the Northeast region and 27.2% in the North; the rest would happen in the Southeast, South and Central-West regions of Brazil.

• In 2013, of 340.2 thousand patients hospitalized due to these infections, 2,135 died in the hospital. It is estimated that if there were universal access to sanitation this 8 number could decrease to 1,806 cases, a reduction of 329 deaths, which indicates a 15.5% decrease in the mortality. Sanitation and Productivity

• According to data from IBGE, in 2008 15.8 million people, or 8.3% of the entire population, indicated having missed their activities for at least one day in the two weeks prior to the survey. Of this total, 969 thousand (or 6.1%) were caused by diarrhea, of which 304.8 thousand were people working and 707.4 attending school or daycare.

• These about 300 thousand employees missed Sanitation and the appreciation 900 thousand workdays with costs to society. of the environment

• The study estimates that in 2012, 849.5 thousand workdays were lost due to absence caused by diarrhea • There is a 13.6% difference between the values of two real or vomit. Of this total, 37% were concentrated in estates, one with and the other without access to sanitation. the Southeast region and 27.1% in the Northeast. The appreciation of real estates with the universal access to sanitation would reach R$ 178.3 billion, therefore, • For every absence, 16.7 hours of work were it would compensate a good amount of the R$ 313.2 lost, which is equivalent to a loss of R$151.13. billion investment needed to achieve universal access. This way, it is estimated that in 2012, R$1.112 billion were spent in hours paid but not effectively worked • It is estimated that in the long term, the universal access to sewage services would cause an increase in the collection of the • The universal access to water and sewage systems would allow a 23% reduction in the total number of days missed Municipal Real Estate Tax, proportional to the average value of due to diarrhea – about 196 thousand less missed days. real estates, which is an estimated increase of R$ 845 million This would cause a R$ 258 million reduction per year. yearly. The expected increase in the collection of Property Conveyance Taxes is of more than R$ 183 million per year. • Workers without access to sewage collection earn salaries, on average 10.1% lower than those who live in places with • It is estimated that almost 500 thousand jobs in sewage collection. The lack of access to treated water caused tourism would be created with the universal access to an average 4.0% loss of labor remuneration. sanitation, such as positions in hotels, hostels, restaurants, travel agencies, transportation companies and others. • In 2012, the average income in Brazil was about R$ 1,432 . The universal access to sewage collection and treated • The income generated with these activities would water would provide more than R$ 88 extra monthly to the average Brazilian worker, which means a 6.1% increase. reach R$ 7.2 billion per year and a GDP growth of more than R$ 12 billion for the country.

• It is estimated that a 6.1% increase in the country’s • The sanitation performance also seems to impact the income, which today is about R$ 1.7 trillion, would growth of tourism. On Latin American economies that are allow a R$ 105.5 billion yearly raise in paychecks better served of sanitation, the influxes of tourists are larger than Brazil’s. Cuba, Chile and Argentina received 238, 176 and 139 foreign tourists respectively for every one • Regarding the impacts on education, the study shows thousand habitants in 2011. In Brazil, this number was only 27 that, on average, students without access to sewage tourists for every one thousand habitants in the same year. collection have a larger educational gap than those with access to sanitation. This way, the universal access to sewage collection and treated water would cause a reduction of 6.8% in the educational gap, allowing an improvement of the average Brazilian worker education in the next years, with ef-fects upon productivity and income. 9 Sanitation and Quality of Life

Positive impacts on Public Health

According to the Ministry of Health (DataSus) more The number of notifications is decreasing in the last few than 340 thousand hospitalizations were notified due to years, indicating improvements in the battle against intestinal gastrointestinal infections in 2013 in the entire country. About infectious diseases. There were almost 125 thousand less 173 thousand were classified by the doctors as “diarrhea and cases than in 2009, reference year of the previous publication gastroenteritis from presumable infection”, a little more than about this topic by Trata Brasil Institute. Between 2009 and 4.6 thousand cases as “amoebiasis, shigellosis or cholera”, and 2013, Brazilian sanitation presented improvements: it is 162.7 thousand as “other intestinal infectious diseases”. Half estimated that 19.2 million people started having access of this total, which means 170.7 thousand hospitalizations to the sewage collection system, increasing from 40.6% to were of children and teenagers up to 14 years old, an age 48.7% the portion of the population covered by the system. group in which this kind of disease is especially dangerous.

Death Incidence Rate by infectious diseases*

Region Hospitalizations % Hospitalizations Incidence for % % people with 2013 in relation to the every 1000 Brazilian sewage collection total inhabitant population

North 57,172 16.8 3.37 8.4 9.6 Northeast 181,466 53.3 3.25 27.8 21.3 Southeast 46,774 13.7 0.55 42.0 73.8 South 32,337 9.5 1.12 14.3 36.2 Central - West 22,493 6.7 1.50 7.5 47.5 Total 340,242 100 1.69 100.0 48.1

gastrointestinal infections would be expected in a year in Effects of the universal access to sanitation the entire country. If 100% of the populated had access to sewage collection, this number would be reduced to about The study shows that if no Brazilian had access to sewage 266 thousand. Sanitation would not avoid hospitalizations collection, 400 thousand hospitalization cases due to completely, but it would reduce its incidence expressively.

Graph of access to sewage collection X Cases of Hospitalization 2003 X 2013 680.000

630.000

2006 580.000 2003 2005

530.000 2004 2008 2010

480.000 2009 2007

Number of Hospitalization 430.000

380.000 2011 2012 2013 330.000 30.0% 32.0% 34.0% 36.0% 38.0% 40.0% 42.0% 44.0% 46.0% 48.0% 50.0% Population satination access (%) 10 Reduction of hospitalization with the universal access to sanitation (in thousands)

425 400 386 375 373 359 346 333 325 319 306 292 279 275 266

225 Number of medical treatment - thousand cases Number of medical treatment 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Sewage Access

In absolute terms, the number of hospitalizations should be reduced by 74.6 thousand cases, 56% of these in the Northeast region. In relative terms, the North and Northeast would be the regions with greater impact, whose number of infections could be reduced by 31.0% and 23.1% respectively.

Reduction of costs

In 2013, the cost of a hospitalization due to gastrointestinal infection in the Public Health System (SUS) was about R$ 355.71 per patient according to the national average. This caused public spending of R$ 121 million in a year, only to treat infected people in the hospitals. Obviously, other expenses such as buying medication for post-hospitalization treatment or expenses with returning to the doctor, paid by sick people and the society are not taken into consideration in this amount. Since the costs of hospitalization are very similar even in different regions of the country , the concentration of cases in the Northeast and North regions ends up increasing the participation of these regions in the overall cost. In 2013, the Northeast was responsible for 52.1% and the North for 16.3% of these expenses.

The reduction of cases that can be accomplished with universal access to sanitation would mean an expressive reduction of costs to the Public Health System. The reduction from 340.2 thousand to 265.5 thousand cases in a year that could be reached with the universal access to sanitation would mean annual savings of 27.3 million, with 52.3% in the Northeast region and 27.2% in the North, the rest would happen in the Southeast, South and Central-West regions of Brazil.

2 The values vary between R$ 320.73 per hospitalization in Goiás and R$ 447.98 in Roraima.

11 Sanitation and Quality of Life

Number of hospitalizations due to infectious diseases* and hospitalizations that may be avoided with universal access to sanitation

Federal Unit Numbers of 2013 Hospitalizations that Annual savings in can be avoided thousand reais

North Region 57,172 17,745 7,431.04 Rondônia 3,907 1,314 467.35 Acre 2,802 785 253.28 Amazonas 4,879 1,379 451.70 Roraima 652 171 60.28 Pará 40,703 12,942 5.797.88 Amapá 883 296 102.01 Tocantins 3,346 858 298.54 Nordeste 181,466 41,971 14,303.76 Maranhão 47,761 11,380 3,895.15 Piauí 18,935 5,448 1,862.41 Ceará 20,739 4,860 1,623.08 Rio Grande do Norte 10,342 2,603 909.38 Paraíba 12,517 2,518 835.20 Pernambuco 15,465 3,991 1,339.75 Alagoas 8,515 1,970 775.59 Sergipe 1,526 385 150.48 Bahia 45,666 8,816 2,912.72 Southeast Region 46,774 3,960 1,478.68 Minas Gerais 17,505 1,141 389.53 Espírito Santo 4,764 978 399.67 Rio de Janeiro 5,531 805 300.19 São Paulo 18,974 1,035 389.28 South Region 32,337 6,401 2,478.07 Paraná 15,623 2,262 899.91 Santa Catarina 6,256 1,724 617.23 Rio Grande do Sul 10,458 2,416 960.93 Central-West Region 22,493 4,569 1,633.34 Mato Grosso do Sul 3,551 845 326.57 Mato Grosso 5,273 1,369 492.65 Goiás 11,912 2,317 801.89 Distrito Federal 1,757 38 12.22 Brazil 340,242 74,646 27,324.88

(*) CID-10: cholera, shigellosis, amoebiasis, diarrhea and gastroenteritis with assumed infectious origin, other infectious intestinal diseases, plague.

12 Reduction of mortality

The analysis also identifies that the universal access to sanitation would have expressive effects over mortality due to gastrointestinal infections. In 2013, of 340.2 thousand patients hospitalized due to these infections, 2,135 died in the hospital. It is estimated that if there were universal access to sanitation this number could decrease to 1,806 cases, a reduction of 329 deaths, which indicates a 15.5% decrease in the mortality. This shows that sanitation not only avoids cases of gastrointestinal infections that require hospitalization, but also reduces mortality rates, which suggests that sanitation, indeed, improves the population’s general health conditions.

2,500

2,400 2,397 2,337 2,300 2,278 2,219 2,200 2,160 2,101 2,100 2,042 2,000 1,983 1,924 1,900 1,865 1,806 1,800 Deaths due to gastrointestinal infections gastrointestinal Deaths due to

1,700 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Sewage Access

13 Sanitation and Productivity

Benefits of Universal Access for Work and Income

The effects due to the lack of sanitation go beyond immediate Costs Estimates implications over the population’s health and quality of life without access to sewage collection and treatment, and Taking into consideration that the average Brazilian worker water distribution services. The reoccurrence of infections in in 2012 had a 39.5-hour work week (or a 5.64-hour workday), children, teenagers and adults affects health, harming school each absence caused 16.7 hours of work lost. Taking into performance and reducing productivity at work, with imme- consideration the average value of R$ 9.07 for a work hour diate and long-term consequences over wages. in the country, we achieve a cost of R$ 151.13 for each absence which, multiplied by the number of workers absent Regarding productivity, three immediate sources of due to diarrhea or vomit adds up to a global value of R$ ‘contamination’ at work arising from the lack of sanitation can 43.2 million for every two weeks. Therefore, it is estimated be identified. First, the lack of sanitation, in increasing the risk that in 2012 R$ 1.112 billion were spent in hours paid but of infections, causes the absence of sick people from their not actually worked. This is a cost for companies and for the work duties, causing expenses to society. Second, workers government that does not result in effective production to more susceptible to this kind of disease have fragile health society, therefore, it is an inefficiency of the Brazilian economy. and, therefore, a smaller productive performance – which also affects their professional ca-reers. Last, recurrent infections The parameters used to estimate these losses in 2012 also serve and children absent from school activities end up harming to simulate how much of this inefficiency could be reduced, their school performance which means, how much could be saved by companies and the government, if workers had universal access to sewage collection and treated water. Having considered all factors that interfere with this phenomenon, the number of absent days of Absence due to diarrhea a worker that lives in a dwelling without treated water could be reduced in 26.5% if he/she had access to these services. In the case of a worker who lives in a dwell-ing without Based on information from PNAD (National Household sewage collection, the access to this service would make Sample Survey) in 2003 and 2008, an analysis was developed possible a 19.6% reduction in the number of days missed. to identify if the deficit of access to sanitation affects people by missing their daily activities due to intestinal infections. For this reason, the universal access to the sewage system This analysis also tried to identify the effect of the lack of and treated water would have a considerable impact over sanitation over the number of days absent from work or workers absences from their occupations. Based on data school. In 2008, 15.8 million people which are equivalent to from 2012, it is estimated that the universal access to 8.3% of the population indicated that were absent from their water and sewage services would allow a 23% reduction activities for at least one day in the two weeks prior to the in the total number of absences due to diarrhea, which survey. Of this total, 969 thousand (or 6.1%) were caused by would fall from 849.5 thousand to about 654 thousand. diarrhea, of which 304.8 thousand were people working and This would mean a R$ 258 million reduction in costs yearly. 707.4 attending school or daycare. The study shows that based on data from 2012, it is estimated that the universal access to water and sewage systems would allow a 23% reduction in the total Lost Days number of days missed due to diarrhea, which would be reduced from 849.5 thousand to about 654 thou-sand. This would cut down costs in R$ 258 million per year. According to PNAD, each absence due to diarrhea makes 3 Numbers from 2013 the worker miss 3 days of labor. This implicates that about 300 thousand workers missed 900 thousand days of work with costs to society. The study shows that the lack of sewage collection and access to treated water increases the probability of a worker missing his/her professional duties and in-creases the number of days missed. In 2012, the study showed that there was a loss of 849.5 thousand workdays due to diarrhea or vomit. Of this total, 37.0% were concentrated in the Southeast region and 27.1% in the Northeast. Estimativas de

14 Absent days due to diarrhea and vomit and absent days that could be avoided with universal access to sanitation*, costs of absences and economy, estimates of 2012

Estimate Absent Absent days that Hours lost in a year Hourly pay C Annual cost with Annual savings with Federal Days (in two weeks) may be avoided (in because of absences (R$/ hour) ** non-worked hours non-worked hours Units two weeks) due to diarrhea (in million reais)** (in million reais)**

North Region 106,783 35,684 14,953,621 7.02 104..95 35.07 Rondônia 4,182 1,421 594,083 7.92 4.71 1.60 Acre 11,965 3,971 1,658,579 7.02 11.64 3.86 Amazonas 15,272 4,734 2,246,804 6.91 15.52 4.81 Roraima 2,609 818 370,959 8.73 3.24 1.02 Pará 63,743 21,940 8,793,292 6.38 56.09 19.31 Amapá 3,481 1,180 510,410 9.76 4.98 1.69 Tocantins 5,531 1,621 779,493 7.70 6.00 1.76 Northeast Region 230,81 62,033 31,934,274 6.05 193.23 52.03 Maranhão 48,407 14,502 6,409,762 6.31 40.42 12.11 Piauí 24,556 6,876 3,269,844 4.93 16.11 4.51 Ceará 32,423 9,163 4,526,909 5.48 24.79 7.01 Rio Grande do Norte 15,260 4,823 2,190,173 6.52 14.28 4.51 Paraíba 17,163 4,311 2,391,852 5.85 13.99 3.51 Pernambuco 42,298 10,391 6,142,833 6.46 39.71 9.75 Alagoas 7,852 1,458 680,323 5.81 3.95 1.19 Sergipe 3,339 852 454,743 7.02 3.19 0.81 Bahia 42,083 9,657 5,867,835 6.16 36.17 8.30 Southeast Region 314,383 44,856 47,209,946 10.51 495.98 70.77 Minas Gerais 90,921 13,013 13,359,738 8.38 111.96 16.02 Espírito Santo 23,705 4,320 3,542,202 8.70 30.83 5.62 Rio de Janeiro 51,859 7,029 7,818,411 10.83 84.70 11.48 São Paulo 147,897 20,494 22,489.595 11.58 260.43 36.09 South Region 119,064 34,083 17,816,501 9.73 193.32 49.62 Paraná 43,784 11,405 6,5193624 10.18 66.38 17.29 Santa Catarina 35,295 10,356 5,403,793 10.20 55.12 16.17 Rio Grande do Sul 39,985 12,322 5,893,084 9.01 53.12 16.37 Central-West Region 78,900 18,861 11,876,496 11.06 131.32 31.39 Mato Grosso do Sul 10,319 2,991 1,551,846 10.15 15.75 4.57 Mato Grosso 25,755 7,317 3,865,669 10.06 38.90 11.05 Goiás 36,271 7,922 5,489,833 9.17 50.32 10.99 Distrito Federal 6,556 630 969,149 17.80 17.25 1.66 Brazil 849,511 195,517 123,790,839 9.07 1.122.43 258.33 (*) Universal Access to sanitation and treated water (**) Prices as in 2013

15 Sanitation and Productivity

Effects on productivity Gains in remuneration

The statistical analysis developed in this report identified This relation can be extrapolated for the entire group of a very strong relation between access to sanitation and the Brazilian workers. The average remuneration for work in worker’s salary. The analysis, based on information from PNAD, Brazil was about R$ 1,432.00 monthly in 2012 . If the access isolated the effect of sanitation on workers’ income through to sewage collection and treated water were universal, the construction of a quite broad statistical model regarding an expressive increase of this remu-neration could be the determining factors of productivity and the remuneration expected due to improvements in productivity. It is for work. Taking all these factors into consideration, it is estimated that this raise in monthly remuneration would possible to separate the specific effect of each one, isolating be over R$88 per worker, which means, a 6.1% increase. the specific contribution of sanitation. The same relation explains why towns with less access to The statistical analysis based on data from the 2012 PNAD sewage collection and treatment systems, generally, have identified that workers without access to sewage collection lower average income. In a town with only 20% of access to earn salaries on average 10.1% lower than those who have sanitation, the average remuneration for work is R$ 1,381, the same employability conditions (education, experience but in one with universal access the expected income is R$ etc.) but live in places with access to sewage collection. 1,498, R$ 166 more than the other. Since the access to sanita- The lack of access to treated water, in turn, imposes an tion is relatively more restricted in poor towns, the universal average loss of 4.0% over remuneration. This difference, as access to these services would contribute to the reduction of abovementioned, already takes into consideration the partial regional inequality within the country. effect of sanitation upon productivity. This way, this difference has a direct meaning: if a worker that does not have access The general improvement with universal access is major. It is to sewage collection and treated water starts to have it, a estimated that the mass of salaries in the country, which today global improvement of his/her quality of life is expected – less is about R$ 1.7 trillion, would go up by 6.1% allowing a raise of morbidity due to diarrhea, reduction of absences and less days R$ 105.5 billion per year. The return of part of these resources away from work, among other aspects – allowing a higher to public coffers in the form of taxes and fees would already be productivity with proportional effects over remuneration. an expressive source to subsidize the expan-sion of sanitation services in the country.

4 Values from 2013

Sanitation X remuneration gains 1,550 1,498 1,483 1,500 1,469 1,454 1,440

1,450 1,425 1,410 1,381 1,396 1,400 1,367 1,352

Average workers’ income workers’ Average 1,350

1,300 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Access to Sanitation

16 Average income gain with universal access to sanitation Monthly in reais, main occupation, 2012

Federal Average Income Income gain with Income gain with univer- Annual income by Income gain with Unit from main occupa- universal access to sal access to sanitation workers (in billion universal access to tion / Monthly in sanitation / Monthly in reais per reais) sanitation (in billion reais per worker worker reais) North 1,066.00 12.5 % 132.96 102.886 12.833 Rondônia 1,212.42 13.5 % 163.10 12.874 1.732 Acre 1,047.56 12.1 % 126.94 4.950 0.600 Amazonas 1,094.71 10.8 % 118.16 21.689 2.341 Roraima 1,337.32 11.9 % 158.88 3.685 0.438 Pará 947.68 13.3 % 125.86 43.579 5.788 Amapá 1,540.84 13.6 % 208.93 5.621 0.762 Tocantins 1,168.99 11.2 % 130.71 10.487 1.173 Northeast Region 907.20 9.1 % 82.59 278.427 25.349 Maranhão 899.15 11.3 % 101.64 34.244 3.871 Piauí 706.31 11.8 % 83.47 14.553 1.720 Ceará 823.42 9.6 % 78.67 41.690 3.983 Rio Grande do Norte 1,007.57 11.8 % 118.70 18.847 2.220 Paraíba 877.70 7.7 % 67.85 19.113 1.478 Pernambuco 1,010.97 8.2 % 82.42 47.498 3.872 Alagoas 876.86 10.6 % 92.78 13.789 1.459 Sergipe 1,029.75 9.1 % 93.71 13.020 1.185 Bahia 925.62 7.3 % 68.02 75.673 5.561 Southeast Region 1,701.91 3.2 % 54.15 865.062 27.525 Minas Gerais 1,326.09 3.7 % 49.04 174.415 6.450 Espírito Santo 1,400.45 5.0 % 69.80 33.188 1.654 Rio de Janeiro 1,759.00 3.7 % 64.28 154.648 5.652 São Paulo 1,896.36 2.7 % 51.93 502.811 13.769 South Region 1,563.88 9.2 % 143.85 296.606 27.282 Paraná 1,632.80 7.5 % 121.81 116.247 8.673 Santa Catarina 1,681.88 10.4 % 175.25 72.767 7.582 Rio Grande do Sul 1,430.74 10.2 % 146.64 107.592 11.027 Central-West Region 1789.52 7.3 % 129.77 170.507 12..364 MatoGrosso do Sul 1,643.83 9.9 % 162.08 28.373 2.798 Mato Grosso 1,626.37 10.7 % 174.77 33.116 3.559 Goiás 1,494.03 8.0 % 118.94 60.629 4.827 Distrito Federal 2,833.44 2.4 % 69.17 48.390 1.181 Brazil 1,431.90 6.1 % 88.04 1,713.488 105.353 (*) Universal access to sanitation and treated water (**) Prices as in 2013

17 Sanitation and education

Positive effects on next generations

Sanitations impacts on performance

Besides the effects on the productivity from the labor force that is working today and who answers for the generation of income in the country, the universal access to services and sanitation would also allow productivity growth for next generations. This happens because sanitation has an expressive effect over school performance, as indicated in the study from the Center of Social Politics at FGV carried out in 2008 as requested by Trata Brasil Institute.

The statistical analysis developed in this report complemented the study identifying the effects of access to sanitation over the years of educational gap in school-age children. The analysis, done based on information from PNAD 2012, isolated the effect of sanitation on the gap between the ideal and the effective educational level of school-age children in Brazil.

Long-term effects

The statistical analysis based on data from the 2012 PNAD identified that students without access to sewage collection have a larger educational gap than those with the same soci- oeconomic conditions but who live in places with sewage collection. The lack of access to treated water, in turn, imposes an even larger delay. In this sense, if access to sewage collection and treated water were given to a student without access to these services, a 6.8% reduction in his/her educational gap is expected, allowing an improvement of his/ her schooling still while in school.This increases the productivity at work, with effects over future remuneration that is incorporated to the estimated gains on the table.

In total, universal access to sanitation is expected to bring an additional R$ 31.6 billion to Brazilian workers’ paychecks, as it is illustrate in the table below. This amount is added to the R$ 105.4 billion income described above, promoting a total increase of 8% in the work remuneration in the long term.

18 Average School performance and sanitation, 2012*, educational gap in years and impacts of universal access

Federal Educational Gap of Estimate of improve- Potential effect on Annual Income Unit the population in ments in schooling the workers’ average from work (in billion school age (in years) due to universal ac- income (reais per reais) cess (for each habi- month per worker)** tant)

North 4.87 0.33 23.02 2.259 Rondônia 4.13 0.28 2.82 0.242 Acre 4.86 0.33 23.17 0.109 Amazonas 4.78 0.32 23.83 0.472 Roraima 4.04 0.27 24.63 0.068 Pará 5.18 0.35 22.36 1.028 Amapá 5.17 0.35 36.27 0.132 Tocantins 4.33 0.29 23.08 0.207 Northeast Region 4.80 0.32 19.60 6.115 Maranhão 4.79 0.32 19.62 0.747 Piauí 5.01 0.34 16.12 0.332 Ceará 4.00 0.27 14.99 0.759 Rio Grande do Norte 5.29 0.36 24.28 0.454 Paraíba 4.81 0.33 19.24 0.419 Pernambuco 5.02 0.34 23.12 1.086 Alagoas 5.13 0.35 20.51 0.323 Sergipe 4.83 0.33 22.65 0.286 Bahia 4.95 0.34 20.89 1.708 Southeast Region 3.85 0.26 28.75 15.248 Minas Gerais 4.02 0.27 24.31 3.198 Espírito Santo 4.18 0.28 26.69 0.633 Rio de Janeiro 4.74 0.32 38.02 3.342 São Paulo 3.52 0.24 30.46 8.075 South Region 3.72 0.25 26.43 5.015 Paraná 3.65 0.25 27.17 1.934 Santa Catarina 3.32 0.22 25.41 1.099 Rio Grande do Sul 4.04 0.27 26.35 1.982 Central-West Region 3.86 0.26 29.29 2.959 Mato Grosso do Sul 4.27 0.29 31.97 0.552 Mato Grosso 3.76 0.25 27.83 0.567 Goiás 3.81 0.26 25.96 1.054 Distrito Federal 3.71 0.25 47.83 0.817 Brazil 4.25 0.29 26.43 31.626

(*) Universal Access to sanitation and treated water (**) Prices as in 2013

19 Sanitation and environmental appreciation Real Estate Appreciation and Gains in Tourism

As seen on the previous sections, the deficiencies in sanitation cause losses to several areas, and this section highlights an additional issue: sanitation improves the urban soil, appreciating the existing constructions and allowing others of higher aggregated value, which causes a boost in the cities’ real estate capital. Besides appreciating assets’ and real estate’s values, the sanitation allows the expansion and appreciation of economic activities that depend on adequate environmental conditions to be exercised, such as tourism.

Real Estate Appreciation

The statistical analysis based on data from the 2012 PNAD revealed that comparing two real estates that are only different in terms of access to sanitation, the one connected to the sewage collection system has a 13.6% higher value. In 2013, the average value of real estates in a city that did not have sewage collection was R$ 84 thousand. When coverage reaches 50% of population, the average price is up to R$ 90.2 thousand, when coverage is 80%, R$ 93.9 thousand; and so on until R$ 96.4 thousand when all dwellings are connected to the system. This effect is especially important to the savings of families with less income, to whom the dwelling is almost exclusively the only asset.

Effect on the states

In national terms, the universal access to sanitation will bring an average of 3.1% appreciation of real estates, but it will have different effects on each state. Those with most deficiencies will feel a stronger effect on real estate appreciation arising from the availability of sanitation. The largest appreciations will be felt in Rondônia (13.2%), Pará (12.2%), Piauí (12.2%), Amapá (11.7%) and Mato Grosso (10.0%). In absolute terms, dwelling’s average value would appreciate more than R$ 10 thousand in Rondônia and more than R$ 9 thousand in Pará, Amapá and Mato Grosso. On national average, the appreciation was estimated in R$ 2.8 thousand in 2012 (values from 2013). Although the appreciation is smaller in places that are already connected to the system, there is an important effect of equity, bringing the value of real estates closer within regions and reducing the negative effects of the “islands of appreciation”. Average real-estate prices according to the proportion of the population with access to sewage collection 98,000 96,377 96,000 95,139 94,000 93,901 92,663 92,000 91,425 90,187 90,000 88,949 88,000 87,711 86,473 86,000 85,235 83,997 84,000 Average real-estate prices real-estate Average 82,000 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 20 Access to sanitation Real-Estate Valorization in cities with universal access to sanitation, estimates for 2012

Federal Average real- Value Increase Income increase with Units estate value R$ with universal universal access R$ access

North Region 79.195 10.4 % 8,259.11 Rondônia 80,157 13.2 % 10,553.65 Acre 75,201 8.8 % 6,623.03 Amazonas 84,058 6.6 % 5,563.04 Roraima 75,692 8.2 % 6,189.54 Pará 77,563 12.2 % 9,486.72 Amapá 77,789 11.7 % 9,103.34 Tocantins 79,525 9.6 % 7,669.87 Northeast Region 61,666 5.7 % 3,496.23 Maranhão 58,875 9.3 % 5,453.08 Piauí 47,206 12.2 % 5,764.50 Ceará 53,655 5.3 % 2,819.19 Rio Grande do Norte 64,674 9.9 % 6,381.50 Paraíba 61,651 3.9 % 2,376.29 Pernambuco 67,492 4.9 % 3,276.09 Alagoas 52,249 7.4 % 3,867.32 Sergipe 63,531 7.3 % 4,611.84 Bahia 67,930 3.0 % 2,057.26 Southeast Region 112,606 0.9 % 1,011.62 Minas Gerais 89,006 0.8 % 744.09 Espírito Santo 89,912 1.8 % 1,652.12 Rio de Janeiro 124,070 1.8 % 2,220.88 São Paulo 120,864 0.5 % 612.25 South Region 99,641 5.8 % 5,797.41 Paraná 98,510 3.4 % 3,342.06 Santa Catarina 107,552 8.2 % 8,837.43 Rio Grande do Sul 96,136 6.5 % 6,236.37 Central-West Region 99,447 5.4 % 5,338.55 Mato Grosso do Sul 85,175 7.1 % 6,034.16 Mato Grosso 89,921 10.0 % 9,000.35 Goiás 86,007 5.7 % 4,906.62 Distrito Federal 159,283 0.9 % 1,377.59 Brazil 91,062 3.1 % 2,845.45

(*) Universal Access to sanitation and treated water (**) Prices as in 2013

21 Sanitation and environmental appreciation

On average, towns with collection and treatment systems Gains from and costs of universal access have larger volume of touristic activities. In other words, the universal access to sanitation would improve business in areas that are degraded today. It is estimated that almost 500 thou- The costs of universal access to sanitation in Brazil were sand jobs would be created in tourism with universal access to estimated in R$ 313.2 billion, as seen on Section 2. The sanitation and environmental appreciation of benefited areas, valorization of real estates, alone, compensates partially this such as positions in hotels, hostels, restaurants, travel agen- investment, since the gains may reach R$ 178.3 billion. From cies, transportation services etc. the regional point of view, in only fifteen Federation units the costs of universal access supersedes the valorization of the real estate. Due to appreciation, part of the amount invested in sanitation infrastructure returns to public coffers in the form of taxes, such as the Municipal Real Estate Tax Income from Tourism (IPTU, in Portuguese) and Property Conveyance Tax (ITBI, in Portuguese), both of municipal competence. It is estimated The income generated with these activities would reach R$ that in the long term, the universal access to sanitation services 7.2 billion per year in wages and a GDP growth of more than would cause an increase in IPTU collection proportional to the R$12 billion to the country. It is worth highlighting that the appreciation of the average real estates’ value, which is an jobs expansion rate will be larger in the Northeast region – estimated growth of R$ 845 million per year. The expected mainly in Paraíba, Rio Grande do Norte and Ceará. However, gain in the collection of ITBI is over R$ 183 million per year. the Southeast region would get 36.7% of the income generated from tourism due to the universal access to sanitation. Besides this effect, the wages of tourism workers who live in Appreciation of Tourism regions with more access to sanitation are higher. Universal access would bring productivity growth to people, revealing how towns with touristic potential can benefit economically Besides increasing the value of the real estates, sanitation from the installment of sewage collection and treatment allows the appreciation of economic activities that depend services. on environmental conditions for its exercise, such as tourism. Tourism is, knowingly, an economic activity that cannot fully develop in regions that lack sewage collection and treatment. The contamination of the environment by sewage compromises, or even annuls the touristic potential of a region.

Number of tourism workers, according to proportion of the population with access to sanitation 2,400,000 2,217,080 2,200,000 2,100,639

2,000,000 1,984,198 1,867,757 1,800,000 1,751,315 1,634,874 1,600,000 1,518,433 1,401,991 1,400,000 1,285,550 1,200,000 1,169,109 Number of jobs 1,052,668 1,000,000 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Access to sanitation

22 Tourism jobs, employment and income that may be creates with universal access to sanitation* , 2013

Federal Jobs in 2013 Jobs that may Income Generation Units be created with universal access (in billion reais)

North Region 64,959 15,987 204.91 Rondônia 8,171 1,790 24.00 Acre 2,860 767 12.35 Amazonas 17,955 1,299 16.27 Roraima 2,290 300 3.45 Pará 24,796 3,749 39.36 Amapá 3,056 2,247 38.40 Tocantins 5,831 5,835 71.08 Northeast Region 277,859 139,836 1,332.48 Maranhão 15,552 2,936 20.76 Piauí 9,689 5,511 41.29 Ceará 43,274 36,613 334.40 Rio Grande do Norte 23,422 18,352 199.35 Paraíba 13,970 17,300 145.79 Pernambuco 57,012 13,508 157.05 Alagoas 16,595 3,896 45.69 Sergipe 12,074 3,459 30.50 Bahia 86,271 38,261 357.64 Southeast Region 968,645 168,787 2,635.12 Minas Gerais 165,625 80,600 1,075.47 Espírito Santo 32,284 12,030 158.77 Rio de Janeiro 234,095 12,448 185.39 São Paulo 536,641 63,709 1,215.45 South Region 273,645 124,252 2,215.91 Paraná 102,162 55,146 1,064.42 Santa Catarina 72,429 22,165 421.19 Rio Grande do Sul 99,054 46,942 730.29 Central-West Region 132,090 51,019 816.21 Mato Grosso do Sul 17,432 15,377 263.02 Mato Grosso 20,657 12,536 212.80 Goiás 45,881 21,915 319.58 Distrito Federal 48,120 1,191 20.81 Brazil 1,717,198 499,882 7,204.62

(*) Universal Access to sanitation and treated water (**) Prices as in 2013

23 Author Execution

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