Maintaining the state or health of rivers is a vital part of sustainable development. Healthy rivers are able to support and maintain key ecological processes and thus ecosystem services on which society depends. The monitoring and reporting of river health is well documented at a local scale, but at national, regional and global scales the existing methods are generally unable to provide useful information. This has resulted in a dearth of river health data and information in the likes of the SDGs, the CBD Post-2020 framework, the IPBES etc., reflecting a world-wide lack of appreciation of this vital natural resource.This report seeks to understand the present global situation of river health (RH) assessment and reporting to develop an understanding of the key attributes of successful approaches, especially in relation to the Emergency Recovery Plan for freshwater biodiversity and GBO5 Sustainable Freshwater Transition (both published in 2019). We restrict our selection of reviewed frameworks to those applicable at either the regional (multi-basin or multi-national) or global scales, as we considered these most likely to possess the traits necessary for global expansion. Where a framework is proposed with the intention to supplant past protocols, the most modern version is used. The report also considers potentially novel ways of moving data to the global scale and ends with the requirements for a global framework for monitoring and reporting on river health. In the process it does not provide detail of site-based methods even where these can be incorporated into global frameworks, as there are already several reviews of such methods. This report focusses on river health and recognizes this as a part of aquatic ecosystem health. While rivers are by nature integrated with floodplain and some palustrine wetlands, with groundwater and with estuaries, the focus remains on the freshwater lentic (flowing) systems. The principles elucidated will however apply to many of the other aquatic ecosystems. Processing of data -data processing usually involves three steps. 1) The aggregation of raw data to the appropriate scale for each metric. 2) Data are standardised to a common scale, to ensure consistency and flexibility. This often involves comparison to reference data.3) The integration (or combination) of data at the indicator, component, or overall ecological condition levels for reporting. Reporting of results -reporting needs to consider the scale of the report, and also how to best communicate the data that is being used. Many formats for such reports have been produced, with perhaps the most useful being circulate pie-charts that provide an integrated score but also allow component scores to aid interpretation.This report provides a baseline to formulate a global RH framework and will be followed up with further steps. Supported by IWMI and funded by the WWF, more conceptual thinking will be done to draft a paper that proposes a way forward for a global RH framework. It is hoped that this will provide a springboa...