Sometimes in the developed world, we pretend that we have sanitation all figured out. But infrastructure is aging since nobody wants to invest in sewage--not particularly glamorous.
To talk about my current home, Atlanta metropolitan agencies have paid more than 6 million dollars in fines in the past dozen years or so because of sewage spills into surface water sources. The policing on this? It's done by the local governments themselves, which leads one to wonder whether all of the spills are being reported. Successful structure is not only the pipes and plants (although that's a problem too)--it's the systems of accountability. Many of the water ways into which this water is spilled gets used as drinking water sources. So we inadequately clean the sewage, it gets dumped into streams, where we pick it up, clean it a lot, have it go through a series of pipes that are falling apart (during which recent works have shown that it is losing its chlorine residual that keeps the water safe in the pipes), and to people. The EPA fines the city because of the dumping and the poor water quality, resulting in the loss of millions of dollars.
What if we just took that money that we keep getting fined for and instead spend it on fixing the infrastructure instead of just flushing it?