The conclusion was that, despite the enactment of the Sanitation Law in 2007 and the provision of resources through the Growth Acceleration Program, the sector features a series of institutional, planning and regulatory inefficiencies. The results have fallen short of initial expectations of increased coverage, largely because, in general, the execution of sanitation construction work is slow. In spite of an increase in federal government resources assigned for sanitation (R$8.9 billion per year between 2007 and 2015), there has only been modest growth in water and sewerage service coverage, and it has not met the sector’s expectations. The study shows that economic regulation ought to be improved in order to meet the goal of universalizing the provision of high-quality services for reasonable prices. The expansion of sanitation infrastructure in Brazil depends not only on supplying more financial resources, but also efficiency gains in the development and execution of plans. It is necessary to improve planning and monitoring of sanitation construction projects in Brazil. This timely study presents evidence of the importance of continuing with investigations into the effectiveness of investments in the sanitation sector. The authors propose expanding the range of samples and, above all, evaluating processes for accessing financial resources and implementing contracts, identifying critical points and proposing mechanisms to solve problems.