Water, health, and rights: challenges of drinking water and sanitation for indigenous communities in Tocantins, Brazil

Indigenous communities in Brazil, particularly in the state of Tocantins (Brazilian Legal Amazon), continue to face persistent challenges regarding water security and sanitation. Historically marginalized by colonial structures and state policies, these populations experience unequal access to safe drinking water and basic sanitation services, undermining health, cultural practices, and environmental justice. This study analyzes the implementation and effectiveness of water supply and sanitation policies targeting Indigenous peoples, with an emphasis on the National Indigenous Peoples Health Policy (PNASPI). The methodology adopted combined a systematic review of literature, national legislation, and health policy documents with the analysis of sanitation infrastructure data from 160 Indigenous villages, sourced from official databases. The review also incorporated thematic mapping and epidemiological data on waterborne diseases, notably acute diarrheal disease (ADD). The results show that only 10% of villages have both water supply systems and sanitary modules, while 30% of the Indigenous population lacks treated water, violating PNASPI provisions. The persistence of high rates of waterborne diseases highlights policy failures and health inequities. The findings call for culturally sensitive, participatory governance models, improved sanitation infrastructure, and the integration of Indigenous knowledge to enhance water security and health outcomes in Indigenous territories.