Rural Sanitation: Scenarios and Public Policies for the Brazilian Semi-Arid Region

Abstract

Brazil’s primary sanitation sector has been neglected, especially concerning rural sanitation. Population dispersion and the difficulty of access in many rural communities bring more significant challenges to the universalization of the service and, consequently, vulnerabilities for the population. The present work builds a theoretical framework about the context of rural sanitation in Brazil, with history, weaknesses in the sector, the impact of COVID-19 and new technologies, and central public policies in the State of Pernambuco. It is known that COVID-19 has caused considerable challenges that, added to the obstacles to national sanitation, result in greater vulnerability to the population, especially for indigenous peoples, quilombolas, and diffuse rural communities. In the State of Pernambuco, certain policies, such as the One Million Rural Cisterns Program (P1MC), One Land and Two Waters Program (P1 + 2), Água Doce Program and Operação Pipa Program, significantly improved the quality of life of the rural population. However, these measures are not enough to remedy the sector’s shortcomings. Although alternative sanitation technologies bring hope to the sector, there is a long way to go towards the universalization of sanitation.

1. Introduction

The definition of rural environment is complex and heterogeneous. In Brazil, within the scope of its national states, there is a set of logic factors for classifying the rural environment for normative, statistical purposes and, consequently, the planning and implementation of public policies [1]. The concept of rural environment and its application to public policies becomes even more complex with the expansion of the urban fabric over rural areas and the growth in the number of people employed in activities considered, until then, as exclusively urban [2].

The conservation of rural social, political and economic structures throughout Brazil’s history has influenced access to public policies and the guarantee of human rights. Public policy areas have a technical-administrative and a political dimension related to the decision-making process. The state is responsible for choosing where, how and when to act [3]. For example, in rural sanitation, the active presence of the government and signing partnerships with communities is an essential tool for the development of strategies to minimize social vulnerabilities and improve health in rural areas [4].

In its popular perspective, the promotion of rural sanitation is an option for a territorialization project that needs to be improved [5]. Rural sanitation should not be represented as a sanitation model conceived by urban dynamics and re-oriented towards rural reality [6]. It is a set of activities in which social processes are developed to complement and even surpass the physical sanitation infrastructure itself. Therefore, sanitation actions must reflect the needs of the population and count on the effective participation of the community in all stages of the process [7].

In addition, the challenges for public policies for water supply and sanitation are even more significant in the Brazilian semi-arid region, where water scarcity tends to increase according to possible scenarios of climate change and land-use changes [8]. In this context, achieving sustainable development goals, especially those related to clean water and sanitation (SDG 6), depends heavily on broad actions and public policies that jointly address the other SDGs, such as the implementation of innovation and technology for water-supply infrastructure, water and effluent treatment (SDG 9), as well as the implementation of actions for more sustainable cities in the challenging conditions of a semi-arid climate (SDG 11). In this scenario, the socio-economic particularities of the rural population are diffused in the Brazilian semi-arid region, such as low level of schooling; low family income (one to two minimum wages); income concentration on only one family member; heavy dependence on government aid and high dependence on daily activities related to women-concentrated water availability also pose challenges to poverty eradication (SDG 1).

In this context, it is observed that the scarcity of water in sufficient quantity and quality has historically been the central factor that increased social inequality in the Brazilian semi-arid region, especially in rural areas. These inequalities were more evident in the context of the new coronavirus pandemic. In that situation, where the increase in the demand for potable water for personal hygiene actions demonstrated the existing contrast to meet the demand between urban areas, which private sanitation companies naturally supply, and rural areas, where the self-management of simplified human supply systems predominates, which, in general, are highly dependent on the seasonality of rainfall.

To solve the challenge of universalizing water supply and sewage collection and treatment, governments in Latin America have historically implemented different public policies [9], generally financed by certain organizations, such as the World Bank [10]. Examples of these public policies in Brazil, with part of the program focusing on water, are PROACRE in the State of Acre and in the northeast of Brazil, the São José Project in the State of Ceará, the Bahia Productive Project in the State of Bahia, the Sustainable Rural Paraiba project in the State of Paraíba and the Sustainable Rural Pernambuco project (PRORURAL) in the State of Pernambuco.

These public policies have investments in the order of magnitude of tens of millions of dollars. However, it is still limited to certain problems, such as the limited sustainability of investments, making universalization goals difficult; insufficient knowledge of the rural universe; lack of coordination between the sanitation sector and other public policies (health, energy and education) and difficulty in coordinating institutions, generating a lack of sustainability in the provision of services. In this case, the present study aims to conduct a literature review on the history of rural sanitation policies in Brazil, its consequences and developments on the national scene, the sector’s main challenges to combat the COVID-19 pandemic, the sanitation sustainability index and alternative technologies for the sanitation of diffuse communities.

2. Methodology

In conducting this systematic literature review, only studies that addressed rural sanitation in Brazil, historical and institutional aspects of rural sanitation in Brazil, and the new coronavirus pandemic’s influence on rural sanitation and rural sanitation indicators were considered.

The research was conducted using the Portal Periódicos-CAPES. The terms used in Portuguese, were “Rural Sanitation,” “Rural Supply,” “Public Policy for Rural Sanitation,” “Sanitation Technologies,” “Rural Sanitation Self-Management,” and “Sanitation in the Coronavirus Pandemic.” The terms used in English were “Rural sanitation,” “Nature-Based Solutions,” “Sanitation technologies,” “Sanitation in the semiarid,” “Sustainable sanitation,” and “Sanitation and COVID-19”. Only studies identified as most relevant by Google Scholar, Scopus and MDPI platforms published in 2022 were considered.

In addition, the methodology applied by Khan et al. [11] suggested five steps for developing a systematic review. The procedure consisted of developing questions that should guide the review, identify the relevant research on the topic, assess the quality of the identified research, summarize the data and interpret the results. Furthermore, the theoretical framework developed allowed for conclusions to be drawn about the perspectives and fragility of the sector with a greater focus on the State of Pernambuco, being structured in the following topics: Demographic census and rural context; History of rural sanitation in Brazil; Public policies and sanitation technologies; Main works on rural sanitation in Brazil; Main works on rural sanitation in some countries; Sanitation sustainability index and rural sanitation and COVID-19.

3. Demographic Census and Rural Context

In Brazil, around 30 million people live in rural areas, representing approximately 16% of the Brazilian population and 8.1 million rural households, according to the 2010 IBGE demographic census. In the 1960s, the percentage of the Brazilian rural population was approximately 55%, which reinforces the rural exodus in the country, which mainly affected small farmers and rural youth. Figure 1 represents the distribution of the percentage of the rural population in Brazilian states, which has suffered a considerable drop over the years. For example, the State of Pernambuco follows the same downward trend as the national panorama: for the 1960 population census, 55% of its population was located in rural areas; in 2010, this was only 20%.

This migration process responds to the vulnerabilities and often unsustainable conditions of survival of the rural population. Motivated by a better quality of life, associated with a greater offer of jobs, access to health, education and basic sanitation services, and fleeing from the mechanization of the countryside and the insufficiency of public policies, the rural population seeks refuge in large urban centers.

The issue of access to water is crucial for overcoming the obstacles to development. When it comes to the widespread use of water in rural areas, especially in semi-arid regions, the expansion and strengthening of water infrastructure, with proper management, are essential for inland development [12]. Figure 2 illustrates the types of water supply according to urban and rural areas in the national, regional and State of Pernambuco contexts.

Both access to good-quality water in adequate quantities and the treatment of sanitary sewage are constitutional rights whose guarantee is the public sector’s responsibility, in a way shared by the three federative spheres, as provided by the National Basic Sanitation Policy (PNSB). However, in much of the global south, the socio-economic scenario contributes to the lack of basic sanitation infrastructures, such as toilets and septic tanks, and the lack of maintenance, resulting in the abandonment of these structures [13]. In Figure 3, the percentages of households with bathrooms and toilets in urban and rural areas in the national, regional and State of Pernambuco context are shown according to the 2010 demographic census (Figure 3a), as well as the typology of sanitary sewage in households in rural areas in the State of Pernambuco (Figure 3b).

4. History of Rural Sanitation in Brazil

The first actions aimed at sanitation in Brazil date back to the colonial period, providing water through fountains, spouts and even minor water pipeline works to certain cities, such as Rio de Janeiro [14]. The European infrastructure model spread across the country between the end of the 19th century and the beginning of the 20th century. The sanitation sector was transferred to the private sector, gas distribution and public lighting. Water distribution networks were implemented by British companies, leading to the closure of public models of water supply to the population, so the commodification of the product essential to the life of the population of urban centers began [15].

The privatization process of sanitation in Brazil had as its only focus the profitability of the water supply; little was thought about the universalization of this right, since areas with a low-population concentration or even communities with low executive power would not be profitable for the process. In this context, the starting point for Brazil’s supply and sanitation system was the exclusion of the poor and those distant from Brazilian urban centers. The concentration of public investments in basic sanitation actions in Brazil in urban centers harms the rural population.

The drought of 1877, one of the most extensive droughts ever recorded, draws attention to discussions on the subject, seeking to mainly help the rural population regarding the related water supply. From that year onwards, some actions were performed, such as the Imperial commissions (1877), Quixadá Dam (1884), Dams and Irrigation Commissions (1904), the Study and Works Commissions Against the Effects of Drought (1904) and the Commission of Drilling Wells in the Rio Grande do Norte (1904). In 1909, these processes triggered the creation by the federal government of the Inspectorate of Works Against Drought (IOCS), later called the National Department of Works Against Drought (DNOCS), the first federal agency to systematize the fight against the periodic droughts that devastated the Brazilian northeast, through the construction of dams and public roads, for example [16].

In 1918, the Liga Pró-Saneamento do Brasil was created, an employee of the General Directorate of Public Health, to work on behalf of sanitation throughout the country, especially in the center, seeking to discriminate information on personal hygiene, fighting common diseases in the rural population, such as Chagas, malaria and hookworm diseases, being directly linked to the Oswaldo Cruz Institute. Its primary focus was the creation of a federal public agency that would standardize the public health service throughout the national territory [17]. The league’s operation ended in 1919 and, despite not achieving its primary objective, it contributed to the creation of the National Department of Public Health (DNSP) in 1920, marking the beginning of the centralization of health and sanitation services at the federal level [1].

In 1930, the Ministry of Education and Public Health (MESP) was created, resulting from the past efforts of the League Pró-Sanitation of Brazil. The National Department of Works and Sanitation (DNOS) was implemented in 1940 and the Special Public Health Service (SESP), which later became the Fundação Serviço Especial de Saúde Pública (FSESP), lost autonomy and links to the Ministry of Health. In 1956, the National Department of Rural Endemic Diseases (DNERu) was created, aiming to organize and execute services to combat endemic diseases in the country. The same decree created the National Institute of Rural Endemics (INERu), whose attribution was to conduct research and studies on endemic diseases in the country [1].

In 1971, the National Sanitation Plan (PLANASA) was created, financed by the National Housing Bank (BNH) and the Sanitation Financial System (SFS), which was supported by resources from the Severance Indemnity Fund (FGTS). The formulation of PLANASA brought about a radical change in the organization of the sanitation sector in Brazil, especially in urban areas, to face the country’s industrialization and consequent urbanization [18]. Therefore, between 1960 and 1990, investments in rural sanitation at the federal level were limited to those related to the DNERu, the Superintendence of Public Health Campaigns (SUCAM) and the FSESP itself.

Another significant milestone was the creation of the National Health Foundation (FUNASA), through the merger of FSESP and SUCAM and, in 1995, the creation of the Sanitation Sector Modernization Program (PMSS). The program acted in the stages of planning, regulation, management and inspection of the provision of services. The Alvorada Project stands out for rural sanitation, which established the implementation of actions by several ministries in territories that had a Human Development Index (HDI) lower than 0.5. Silveira [1] highlights that some of the main lines of action were fighting rural poverty, increasing the coverage of water and sewage services, emancipating and consolidating rural settlements and prioritizing rural electrification in the north and northeast regions.

In the 2000s, some essential institutional advances were achieved, such as the creation of the Ministry of Cities and the National Secretariat for Environmental Sanitation in 2003, the Growth Acceleration Program (PAC), the regulation of Law 11,445/2007 and the elaboration of the preliminary version of the National Basic Sanitation Plan (PLANSAB) in 2007. The PLANSAB, officially approved in 2013, proposed the definitions of three programs: Integrated Basic Sanitation, which corresponds to investments in urban areas of the four axes of basic sanitation and must be coordinated by the Ministry of Cities; Structuring Sanitation Program, which aims to provide technical support to management and must also be coordinated by the Ministry of Cities; and Rural Sanitation, which includes all interventions in rural areas and must be coordinated by the Ministries of Health and FUNASA [19].

The National Rural Sanitation Program (PNSR) must allocate funds and recommend actions to promote progress in sanitation coverage in rural areas, covering the rural population and traditional communities, such as indigenous and quilombolas, and extractive reserves. The objectives of the PNSR are focused on the promotion and development of basic sanitation actions in rural areas with a view to universal access, based on principles of equity, integrality, development in multiple sectors, sustainability and social participation. Furthermore, based on the premise that “sanitation should not have borders, but horizons”, the program seeks to define guidelines and strategies for actions in rural areas and guarantee the universalization of sanitation within 20 years [20]. Figure 4 shows the timeline of the main actions for rural sanitation in Brazil.

5. Public Policies and Sanitation Technologies

In the country’s northeast region, the implementation of policies of the Integrated Rural Sanitation System (SISAR) stands out. Created in 1996, with the support of CAGEPE, the KFW Bank and the Government of the State of Ceará, the SISAR is a non-governmental civil association whose objective is to guarantee the operation and maintenance of the water systems and sewage of affiliated associations, performing activities of water control and system’s performance, supply of inputs and water capture [21].

The SISAR emerged as an alternative to the social inclusion of diffuse populations, who need particular forms of intervention in basic sanitation, seeking to guarantee the constitutional right of access to health and essential services [22]. A prominent factor that explains the program’s success is the empowerment of communities and their immersion in the project, seeking to improve their quality of life [23]. According to the organization’s website, in January 2022, the eight SISAR units in Ceará totaled 1202 installed systems, benefiting around 820,000 people.

In 2021, the government of Pernambuco inaugurated the first SISAR unit in the state, SISAR Moxotó, covering the municipalities of Arcoverde, Buíque, Custodia, Ibimirim, Itaíba, Manari, Pedra, Sertânia, Tupanatinga and Venturosa. This system aimed to promote basic sanitation for rural communities, with an estimate to serve 120,000 people from 622 communities and 30,000 rural properties [24].

In addition, as federal government action, the Água Doce Program stands out as fundamental to the Brazilian semi-arid region, as it aims to ensure more outstanding durability and good functioning of desalination plants through the collective self-management of community systems. In addition, the program also includes the concern for the waste produced by the process, the saline concentrate, which is commonly disposed of inappropriately [21]. By the year 2021, there will be 840 desalination systems in operation, providing drinking water to rural communities in Alagoas, Bahia, Ceará, Pernambuco, Piauí, Rio Grande do Norte and Sergipe.

In Pernambuco, the Água Doce Program diagnosed 510 communities in the 21 most critical municipalities in the state in terms of access to water. Projects were prepared for the construction of 170 systems, and the implementation works that were initiated in August 2020 are in full execution. It is estimated that the systems will have the potential to provide good-quality water to up to 68,000 people living in rural communities in the semi-arid region of Pernambuco [25].

Currently, several organizations that are part of the ASA/PE run the Training and Social Mobilization Program for Coexistence with the Semi-arid Region in Pernambuco, which has two main actions: the One Million Rural Cisterns Program (P1MC) and the One Land and Two Waters Program (P1 + 2). These programs seek to improve the quality of life of the rural population through the construction of cisterns made of plates and boardwalks, underground dams and stone tanks. In addition, the benefited families effectively participate in the construction process and spaces for professional qualification and citizen training.

Another important public policy in the State is the Operação Pipa Program. This is a mutual technical and financial cooperation between the Ministries of Regional Development and the Defense, implemented in 1998, to perform complementary actions to support the activities of distributing drinking water, primarily to rural populations affected by drought and drought in the northeastern semi-arid region and northern region of the states of Minas Gerais and Espírito Santo [26]. For the municipality to participate in the Emergency Water Distribution Program, it is necessary to declare a state of emergency or public calamity. This situation is recognized by the state government and the Ministry of National Integration.

The Brazilian Army works by planning and executing water distribution through information surveys and recognition of the municipalities served, hiring water trucks for water distribution to communities, control and inspection, preparing management reports and accountability of financial resources [27]. For control and inspection, the Army relies on the Gestão Pipa Brasil platform (GPIPA), a georeferenced platform for monitoring work and delivering water to the communities served. In Pernambuco, the 72nd Motorized Infantry Battalion is responsible for the operation.

Table 1. Quantitative aspects of Operação Pipa Program in the State of Pernambuco between March 2020 and February 2021.

Month	Municipalities Served	Number of Water Cars	Population Served
Mar/20	109	1123	536.898
Apr/20	93	989	471.942
May/20	100	906	469.874
Jun/20	107	1082	536.768
Jul/20	102	1088	529.098
Aug/20	105	1085	526.491
Sep/20	110	1068	540.181
Oct/20	108	1077	528.582
Nov/20	105	1056	493.273
Dec/20	105	1064	532.535
Jan/21	105	987	438.685
Feb/21	91	926	460.356

shows the number of municipalities, water trucks and the population served in the State of Pernambuco between March 2020 and February 2021.

Rural sanitation in Pernambuco is currently treated in a relatively fragmented way by a multiplicity of actors (COMPESA, SRH, Secretariat of Agriculture/IPA, ProRural and City Halls). Knowing that the state has about 850 districts and villages spread across its territory, most of which lack regular water supply systems or are poorly supplied, the implementation of integrated supply and sanitation actions in these communities is essential for the interiorization of the country’s development and improvement of the population’s quality of life. In this context, the Sustainable Rural Pernambuco Project (PRS), arising from a partnership between the World Bank and the Government of the State of Pernambuco, guarantees investments initially destined for rural infrastructure and production projects in various developing regions of the state. As part of rural sanitation, fountains, dams, cisterns, water supply networks and bathrooms were built in various rural associations in the state.

In the PRS, the cisterns were implemented in two axes, the first resulting from the initial planning, via resources from the World Bank and counterparts from the associations, and the second through an investment from the Ministry of Social Development (MDS) in the cisterns program. In total, 19,863 cisterns were built, 92.56% of which came from the MDS, as shown in Figure 5.

The issue of public policies has undergone significant and marked transformations over the last few decades, but there are still many challenges in sanitation management. The extensive use of traditional sanitation techniques is one of the main reasons for environmental and public health concerns. Therefore, the current challenges of universalizing basic sanitation, preservation and availability of water resources require society to implement new efficient technologies. In this regard, certain innovations, such as Artificial Intelligence (AI), Big Data, the Internet of Things (IoT), Blockchain, Drones and Virtual and Augmented Reality (VR/AR), are innovations that offer solutions to traditional problems in basic sanitation. These technologies are being used to combat water waste through the capture and distribution processes and improve resource management [28].

In their studies, Gore et al. [29] proposed an analysis framework based on IoT and cloud computing to analyze data from toilets built in India. The “Clean India Mission,” a public hygiene policy initiated in 2014, aimed to implement public toilets in rural and semi-urban areas to eradicate waste dumping in the open. The use of IoT and cloud computing serves as a basis for providing intelligent decisions regarding the use and maintenance of these infrastructures. Other practices that are in evidence are Nature-Based Solutions (NbS). The International Union for Conservation of Nature (IUCN) defines these solutions as actions to protect, manage and restore natural or modified ecosystems sustainably, while seeking social well-being [30].

In the scope of sanitation, whether urban or rural, these techniques aim to effect natural ways of treating water and sewage, using little or no chemical compounds, which may be harmful to nature. The NbS, in urban areas, works by decentralizing the treatment of effluent, offering the greater possibility of reuse of water, sludge and gas. In addition, it reduces energy expenditure in Sewage Treatment Stations (ETE) and the construction of large effluent capture systems. In rural areas, the NbS, due to its decentralized characteristic, is an efficient alternative for sewage treatment in households. Furthermore, it allows for the construction of several treatment points, preventing sewage from being dumped in the open [31].

There are several alternatives for water and sewage treatment through NbS. Among them, we can mention the following: wetlands built for tertiary treatment combining traditional systems with a natural treatment stage, allowing for the recovery of river ecosystems and the use of the area for planting. Tanks for water treatment and reuse can be used from large cities to small communities, where wastewater is directed to tanks and subsequently treated. Filtering gardens, which is effective, even for the treatment of sanitary effluents combined with waste from industrial processes, with no entry of chemical products for the treatment, with the filtering process conducted by phytoremediation, sandboxes and aeration. Compact container-style treatment systems: these practices can be used in a modular way, meeting the urban demand of up to 90 thousand inhabitants; they are easy to maintain, require few people in operation and the treatment units, coupled according to the need for local treatment, are usually used together with constructed wetlands [32].

Tompkins et al. [33] emphasize in the context of the INNOQUA project the importance of NbS, especially in the rural setting, describing the assessment of the natural technologies addressed in this study. Four NbS were evaluated, each at different levels of technological readiness: the UV disinfection unit; bio-solar purification unit; lumbrifilter and Daphnia filter. According to the authors’ analyses, such solutions are capable of providing low-cost and sustainable wastewater treatment in rural and urban areas around the world.

Effluent reuse technologies are being used in small amounts and have not been the object of large-scale application in public policies. Indeed, the use of these techniques on a large scale can contribute to improving water security. However, the main actions have focused on increasing the volume of water stored in hydrographic basins and improving the water storage capacity in homes and schools with cisterns from sixteen to fifty-two cubic meters. Despite the potential to use technologies for the collection and treatment of effluents, some challenges, such as community acceptance and training and capacity building of communities for operation and maintenance, should be encouraged.

6. Main Works on Rural Sanitation in Brazil

In the national scenario, basic sanitation in rural areas lacks systematic and practical action by the public authorities. Scattered public policies, multiple agencies, uncoordinated action and the lack of long-term planning are the most worrying factors observed [34]. Thus, rural sanitation remains an autonomous subdivision of municipal sanitation and an unmet requirement for a large part of the diffuse rural population. Moreover, this scenario reinforces the lack of strategic policies at all levels of government, continuous funding and joint action by rural communities.

As infrastructure works, investments in basic sanitation are very high, and the financial return occurs in the medium and long terms. This drives investments to urban areas, where payback can occur more rapidly, which puts the rural area on the sidelines of the service [22]. In this context, Silva et al. [4] studied socio-environmental vulnerabilities in rural communities in Brazil’s north and northeast regions. Moreover, they identified a clear division of labor for access to water and sanitation from the perspective of gender. When sanitation is inadequate, the impact on women’s health and quality of life is more remarkable. They are assigned roles related to the home environment, whose more significant influence is on water and sanitation.

Reinforcing the need for public policies, Castro, Taleires and Silveira [22] investigated the human development of eight rural municipalities in Ceará with the Integrated Rural Sanitation System (SISAR) and 170 that do not. The results corroborate the importance of having treated water and sanitation to increase some of the human development indicators. In this study, the longevity and education dimensions proved to be higher in the municipalities with SISAR, contributing to the increase in these municipalities’ Municipal Human Development Index (IDHM).

In the history of rural sanitation, there are reports of difficulties in managing and implementing public policies, generally caused by pre-determined exogenous actions that do not respect the local context. Machado, Maciel and Thiollet [35] point out the need for dialogue in implementing sanitation actions, especially in rural areas, involving the individual, the groups served and their territorial culture. The panorama discussed shows the importance of a global understanding of the problem and, at the same time, a local action adapted to each reality.

Ferreira, Lessas and Silva Filho [36] studied ecological sanitation in a rural community in the Brazilian semi-arid region, and reinforced the importance of community involvement throughout the diffusion process. The term “ecological sanitation” prioritizes adopting a system that enables the recovery of organic compounds and their use for the production of organic fertilizer and/or biogas. With community awareness about the risks of inadequate sanitation conditions, green pits were built at low implementation, operation and maintenance costs, as well as the possibility of reusing water, a scarce resource in the semi-arid region.

Coelho, Reinhardt and Araújo [37] indicate the green pit as a viable alternative for rural communities lacking public sanitation services. They emphasize that products grown with a green pit are suitable for consumption, provided that care is taken with the handling of vegetables, avoiding cross-contamination in the food. Souza et al. [38] studied the effects of using a pre-treatment unit to generate a nutrient-rich effluent for crop irrigation. This is yet another easy and low-cost option that would positively impact the sanitary and health conditions of rural populations, particularly in the north and northeast of Brazil.

Costa and Guilhoto [39] point to favorable economic returns for the economy due to spending on sanitation, even for simpler technologies available for rural areas, such as the biodigester septic tank. It was found that, per year, the construction of this system could reduce about 250 deaths and 5.5 million infections caused by diarrheal diseases, and reduce the pollution of watercourses in about 129 thousand tons of waste. Furthermore, the authors observed that each BRL 1.00 invested in implementing this alternative could generate a return to society of BRL 1.60 in gross domestic income. It is also worth noting that additional gains are made if the effluent generated in this system is used to fertilize crops.

7. Main Works on Rural Sanitation in Some Countries

Semi-arid regions, characterized by low rainfall and high evapotranspiration, are the locations that present more incredible difficulty in terms of the availability of water resources and basic sanitation. Therefore, solutions for the implementation of basic sanitation are necessary to guarantee the survival of the local population. The reuse of water, for example, can increase the availability of water in these regions, contributing to water security, economic dynamism and biodiversity [40]. In this topic, current solutions and studies related to sanitation in semi-arid regions worldwide are presented.

Raphaëlle Ducrot [41], in her study, evaluates the implementation of the Mozambique—National Rural Water Supply and Sanitation Program project in the Mabalane district, located in the semi-arid region of the Limpopo Basin. The objective was to promote community self-management in essential sanitation services. Interviews were conducted with the communities’ families, obtaining data, such as the payment of water supply fees. The author highlighted the importance of articulating community leaders in the sustainability of small rural supply infrastructures, the need for technical monitoring to subsidize more complex issues and, finally, the application of studies of indicators in communities to measure the quality of the process of implementation.

Fischer et al. [42] studied the unintended consequences of transferring responsibility for managing rural sanitation services to families. The study was conducted in Bangladesh. According to the authors, the transfer of responsibility for the sanitation service generated an informal market lacking regulation and exacerbated wells’ exploitation as sources, compromising the sustainability of water resources. Therefore, the need for Bangladesh to regulate the country’s water governance systems was identified as a result of this work.

Serrao et al. [43] evaluated the potential for reuse of wastewater for irrigation in rural areas, treated using three technologies: Septic tank and constructed wetland (ST + CW); Earthworm filter (EWF) and membrane bioreactor plant (MBR). The study occurred in the Coquimbo Region of Chile. The water balance performed by the authors showed that treated wastewater sources could partially replace traditional water sources. Furthermore, the applied multi-criteria analysis revealed that farmers prefer ST + CW as the most appropriate technology to treat and recycle effluents, as it is a simple operation technology.

Pundir et al. [44] conducted a study on the influence of the Water Safety Plan (WSP), developed for rural water supply in Dehradun district, Uttarakhand, India. In identifying the contamination risks, the authors presented the reduction in this danger with the application of the project and its control measures and the improvement of water quality, with the decrease in turbidity parameters, total dissolved solids and total coliforms. However, the authors stated that it was still necessary to empower rural communities to protect their water sources and sustainable water supply management.

Turrén-Cruz et al. [45] proposed a study to identify the variables and indicators that allowed for the integration of human issues (user preferences) in selecting technologies for basic sanitation systems and services. The study was applied to rural communities in Chiapas, the poorest State in Mexico. The technical characteristics, cost of the systems and socio-economic aspects were the most important in providing sanitation services. Therefore, the authors highlighted the importance of understanding the local culture and preferences before providing a solution for basic sanitation to be well accepted and efficient.

The Development of Ecological Sanitation (EcoSan) technology, a basic sanitation technology program, has dramatically improved the problems and costs related to water consumption, water resource management and waterborne disease control. However, Mayaka et al. [46] stated that Urine Diversion Toilet (UDT), an Eco-San, was not well understood in rural communities in Kenya, being inefficient for the population. In this aspect, the article presented a study on the improvement in the design of the EcoSan bathroom, aiming to make it acceptable among the population. Furthermore, the improvement aimed to increase the ease of use of the system and make it more hygienic. This fact directly contributes to the health of families in the communities by implementing the solution in basic sanitation.

González-Rodrigo et al. [47] evaluated the impact of the “Usafi wa Mazingira Tan-zania” (UMATA) program in the rural area of the city of Chamwino. The Government conceived UMATA of Tanzania to promote greater access to and improved sanitation facilities for communities to meet the Sustainable Development Goals. As a result, regular campaigns were presented to collect household data on the sanitation situation, the types of existing toilets and their location. As a result, there was a reduction from 40.7% to 9.7% in open defecation with the program’s implementation.

8. Sanitation Sustainability Index

The use of indicator systems is essential to evaluate the performance of products, sectors, companies, regions and even countries to simplify an evaluation that would otherwise be more complex and subjective. Sustainability indicators can capture social, environmental, economic-financial and operational information and allow for the evaluation of different sanitation systems, comparing their sustainability and determining the adequate system for the community. However, as the concept of sustainability is complex and contested, several approaches and ways of evaluating it in a sanitation system reflect different views on the subject and social perspectives [48].

Lundin, Molander and Morrison [49] studied applying a set of indicators in Gothenburg’s water and sewage system. Quantitative information on water consumption, energy use and discharge loads, and qualitative information on drinking water quality, sewage sludge quality and ecosystem status were analyzed, validating the system’s sustainability. Hashemi [50] evaluated implementing two sanitation systems in South Korea, a septic tank system and a resource-oriented sanitation system, considering the technical, social and economic aspects. The results showed that a resource-oriented sanitation system is more sustainable for South Korea, which has a long history of using human waste as fertilizer. Finally, Iribarnegaray et al. [48] created a sustainability index applied to four cities in the province of Salta, in northern Argentina. The index was built with nine descriptors and fifteen indicators that covered all the essential aspects of the analysis and reinforced the problems in the sector.

In Brazil, the importance of sustainability of sanitation systems is evident, especially in diffuse rural communities, where investment is low and dependence on public policies is high. As a result, certain agendas, such as ecological sanitation, have been gaining prominence, with the recovery of organic compounds and water reuse, especially in the semi-arid region. The use of green pits, for example, has increased the scope of studies in rural areas due to the low implementation, operation and maintenance costs. Despite this, a good part of the studies on the sustainability index focuses on the evaluation of regional sanitation companies, which do not always cover diffuse rural communities or isolated projects with a small coverage area.

Liu et al. [51] used the Water Poverty Index (WPI) to assess water-poor regions in China. The index based on five components (Resources, Access, Capacity, Use and Environment) can be an essential indicator for the selection of priority areas when designing public policies for water supply in the rural environment in arid and semi-arid regions or of water stress in localities [52].

9. Rural Sanitation and COVID-19

The COVID-19 pandemic has brought new challenges to Public Administration; governments have been forced to make decisions at very rapidly and with minimal information [36]. For Giné-Garriga et al. [53], to combat the pandemic’s advances, most governments adopted measures to promote access to water and sanitation services. Xiao et al. [54] and WU et al. [55] emphasized that access to water supply and sanitation services has become essential in combating the spread of the virus. In Brazil, the impacts of the COVID-19 crisis added to the considerable challenges that the country was already facing in the sanitation sector, as the lack of access to these services is worrying.

The lack of access is especially accentuated in the north and northeast regions of the country and the low-income segments, in indigenous villages, urban peripheries, informal settlements and slums. In Brazil, indigenous communities are potentially vulnerable. In addition to challenges in accessing water and sanitation services, limited access to hospitals and basic infrastructure causes a fatality rate of COVID-19 among indigenous peoples that is twice as high as the country’s national average [25].

For example, in Brazil, the World Bank monitored the response of 18 federative units and sanitation companies. The mapping was based on four pillars: (i) preserving the health and well-being of all people, meeting their basic sanitation and hygiene needs; (ii) intensifying awareness campaigns for infection prevention and control (IPC) and efficient use of water; (iii) guarantee the continuity and safety of essential sanitation services; and (iv) provide technical and financial support to sanitation service providers [25].

The essentiality of water to life has perhaps become more evident with the COVID-19 pandemic [56]. The sanitation service providers were given the responsibility of guaranteeing the population the maintenance of a potable water supply, implementing two policies aimed at urgent water availability: (a) prohibiting water-service providers from suspending supplies to defaulting customers; and (b) obliging water-service providers to exempt from payment, during the pandemic, consumers who qualified for the social tariff [25].

Some regulatory agencies froze tariff adjustments during the pandemic. In addition to these policies, some companies adopted additional measures in response to COVID-19, such as negotiating overdue accounts, strengthening water supplies with water trucks and tanks in informal settlements, installing lavatories in cities and partnerships with NGOs for the distribution of kits with soap and other hygiene products in vulnerable communities [25].

Despite this, public policies were not offered on a national scale that favors consumer payments for essential sanitation services or provides financial support to consumers or providers of public services. It is also possible to note the lack of active measures aimed at sanitation and facilities, especially for those who use public and shared bathrooms, increasing insecurity and the risk of disease transmission, especially in informal environments [25].

In Brazil, it was observed that controlling the pandemic was more difficult in locations that had less access to sanitation services, such as water supply and sanitation. Naturally, the context of the pandemic imposed an increase in the demand for water in homes [57]. For example, for the low-income population, rural population and indigenous communities, mainly in the northern region of Brazil, it was difficult to promote basic hygiene actions, such as hand washing, making it difficult to prevent infection caused by the new coronavirus. From a social point of view, there was an interruption of school activities, causing damage to the training of children, evidencing the need for actions and adaptations of school infrastructure to resume activities [58]. It is necessary to pay greater attention and innovation to water supply infrastructure for different service scales, both in the poorest urban centers and in regions with low population density or diffuse populations [59]. In the case of regions are far away from significant water supply systems and for the diffuse population, there was a need to reinforce the service, using water trucks, or simplified systems and equipment, for emergency and temporary assistance to guarantee meeting the demand.

In addition, quickly and easily identifying the population with the most significant degree of vulnerability and the natural capacity of the local health system to provide care can be essential tools to increase resilience in controlling the pandemic [60]. Indeed, disseminating information on social networks, such as Twitter, Telegram, Facebook, Whatsapp and Instagram, is good practice for promoting self-hygiene and the rational use of water in regions with water scarcity.

10. Conclusions

This article demonstrated the scope of Brazilian rural sanitation for semi-arid regions. The context, dimension and challenges for the universalization of clean water services and sanitary sewage services, and the fight against water poverty, from the perspective of the global objectives of sustainable development and the experiences of rural sanitation in Brazil were analyzed. Presented on topics such as the Demographic Census and Rural Context, History of Rural Sanitation in Brazil, Public Policies and Sanitation Technologies, Main works on Rural Sanitation in Brazil, Main works on Rural Sanitation in some countries, Sanitation Sustainability Index, Rural Sanitation and COVID-19 sought to contribute to the complex challenge of managing solutions for water supply in semi-arid regions.

Despite public policies for the water and sanitation sector, there are numerous obstacles to universal service, especially in rural areas. Institutional gaps around rural sanitation leave room for initiative actions and their challenges. It is known that there is no global or singular solution for Brazilian rural sanitation projects, mainly because of the peculiarities of each region and the agents involved. Therefore, it is crucial to involve the community throughout the dissemination process, combining technological interventions with social approaches.

The review of the central public policies historically shows that actions to combat drought and improve water supply in the Brazilian semi-arid region occurred through public policies that sought to promote greater infrastructure for water storage, such as large dams. More recently, actions have been established to ensure water security, focusing on systems that allow for the self-management of small water-supply networks and cisterns, desalination plants and water points for collective service. It was observed that more significant efforts should be designated to the technical training of the communities to reduce the risks of water and soil contamination (in the case of desalination plants) and to promote practices of rational use of water, as well as how technical and social training actions should be promoted for community associations that practice the management of water supply services for rural sanitation in areas with low population densities in the north of Brazil.

This scenario places the rural population in a situation of vulnerability, especially women, who perform most of the activities related to sanitation. Therefore, it is noted that several articles have analyzed the impact of simpler sanitation technologies, such as green tanks and biodigester septic tanks, in diffuse rural communities lacking public sanitation services, mainly in the Brazilian semi-arid region. These actions, even if isolated, constitute an alternative to minimize the emissions of polluting loads, preserve the quality of water resources and, consequently, develop the region socio-economically.

The COVID-19 pandemic highlighted the shortcomings of the Brazilian sanitation sector, as access to water supply and sanitation services are fundamental to combating the spread of the virus. Despite the suspension of the interruption of the water supply service due to default and exemption from payment to consumers of the social tariff, effective policies were not offered on a national scale, especially for particular groups facing greater vulnerability. With the crisis that followed the pandemic, the promotion of investments in the sanitation sector became even more complex, and the perspective of the rural community has become even more worrying.

In this context, the pandemic demonstrated the need to increase the water supply in regions with high water deficits and moderate demand on an emergency and exceptional basis. It is observed that decisions of a socio-economic nature, such as reduction, exemption or impossibility of increasing the tariff during the pandemic, had to be made together with technical decisions to increase the water supply, either through simplified systems for the water supply or service by tank trucks. There was also a need for compact and innovative systems to promote hygiene, with low water consumption and suitable water treatment and reuse efficiency. Indeed, the design of simplified, portable systems with easy operation and handling capabilities by communities at different stages of educational backgrounds and with different cultural habits tends to be a challenge that needs to be overcome to improve the resilience of communities.