Of the five Brazilian geographic regions (North, South, Southeast, Northeast, and Central-west), the North, including the estuarine Amazon region, has the worst sewage rate. On average, it has only 14% of the overall index of sewage access. For example, Macapá (Amapá state) is served by only 10.7%, and Porto Velho (Rondônia state) is served by 4.78%, both leading the worst national sewage service rates (Sistema Nacional de Informações sobre Saneamento (SNIS), 2020).