The case study concludes that Brazil’s urban wastewater sector still largely struggles with overcoming barriers to wastewater collection and treatment, but it has great potential for wastewater reuse that has not yet been fully tapped, despite initial promising initiatives, mainly for industrial reuse. Financial resources have increased in the past, yet access is difficult for small municipalities and, in particular, public utilities forego the revenues needed for investment in maintenance, operation and expansion, due to inefficient management. The strict de jure legislation does not reflect reality and complicates processes that are already complex due to the many agencies and bureaucratic levels involved. Politically, although sewage has become more important for voters, it still continues to be only one concern of many. The low connection rate to the public sewerage system is socially problematic and leads to lost revenues for the service provider. In particular, public utilities face limited planning as well as a lack of technical and managerial capacity, which translates into a lack of operational and maintenance skills. Urbanisation pressures and water scarcity can catalyse change, in particular by raising awareness about the importance of adequate wastewater collection and treatment and about the potential of wastewater reuse.