<p>Sanitation management in Brazil is strongly shaped by state-level public policies, with service provision largely carried out by mixed-capital companies under public administration. Evaluating the efficiency of these services is crucial to understanding how governmental efforts translate into access to potable water and sewage treatment. This work aims to examine the efficiency status of the sanitation service in Brazil based on a Data Envelopment Analysis (DEA) cost-efficiency framework, inferring strategic positions based on production indicators of different production perspectives: sustainability, water provision, and sewage treatment. Input and output data from the National Sanitation Information System (SNIS) were collected to investigate public policies implemented in the sector over the last decades and how they converge in the studied scenario. The costs are exploration expenses, and the outputs are water consumption, network extension, the number of active water connections, and the number of active sewage connections. As a result, only 8 out of 26 (30.77%) Brazilian water and sanitation providers are technically efficient, with maximum sewage collection rates among efficient providers reaching just 75.79%. The average efficiency score across all service units is 0.8665, and several efficient utilities still exhibit moderate to high levels of water losses, indicating substantial room for improvement. We identify significant disparities in the cost-efficiency and service quality of Brazilian water and sanitation providers, highlighting benchmark utilities with best practices. The study also demonstrates how integrating efficiency scores with sustainability and operational indicators can help prioritize policy actions and drive improvements in resource management and service delivery.</p>