When water problems extend beyond the borders of local communities, the river basin is generally seen as the most appropriate unit for analysis, planning, and institutional arrangements. In this paper it is argued that addressing water problems at the river basin level is not always sufficient. Many of today’s seemingly local water issues carry a (sub)continental or even global dimension, which urges for a governance approach that comprises institutional arrangements at a level beyond that of the river basin. This paper examines a number of arguments for the thesis that good water governance requires a global approach complementary to the river basin approach. Subsequently, it identifies four major issues to be addressed at global scale: Efficiency, equity, sustainability and security of water supply in a globalised world. Finally, the paper raises the question of what kind of institutional arrangements could be developed to cope with the global dimension of water issues. A few possible directions are explored, ranging from an international protocol on full-cost water pricing and a water label for water-intensive products to the implementation of water footprint quotas and the water-neutral concept.