Declining water quality and ecological condition is a typical trend for rivers and streams worldwide as human demands for water resources increase. Managing these natural resources sustainably is a key responsibility of governments. Effective water management policies require information derived from long-term monitoring and evaluation. Biological monitoring and assessment are critical for management because bioassessment integrates the biological, physical and chemical features of a waterbody to provide an indication of ecological condition. Investment in nationally coordinated riverine bioassessment in Australia has almost ceased and management questions are focussed on more localised assessments. However, river systems often span political and administrative boundaries, and their condition may be best protected and managed under national policies, supported by a coordinated national bioassessment framework. A nationally coordinated program for the bioassessment of riverine health is an essential element of sustainable management of a nation’s water resources. From examining the international experience in riverine bioassessment, a series of attributes of successful broad-scale programs emerge. A range of emerging technologies and approaches, such as molecular techniques and trait-based diagnostics, could help improve the efficiency of bioassessment and its suitability to meet the challenges of current bioassessment and future broad-scale programs. A reinvigoration and modernization strategy is needed to avoid the risk of bioassessment losing relevance and currency, and to address the longer-term needs of riverine ecosystems.