Recent developments in water law, policy, and community attitudes in China have created the need for consistent nationwide assessments of river health. River health assessments have been undertaken in various catchments throughout China, but mainly as a research activity. China currently has no ongoing river health assessment programs linked to river management policy operating at any jurisdictional level. This chapter discusses the rationale behind the framework for a national program to assess the health of China's rivers, developed collaboratively over the period 2010–12 by Australian and Chinese scientists, and supported by the Australian Agency for International Development (AusAID) as part of the Australia China Environment Development Partnership (ACEDP). The recommended framework was shaped by Australian experience, and tailored to suit the resources and expertise available in China, the biophysical characteristics of China's rivers, and the key management issues.