This paper presents changes in water and sewage management in the cross-border Oder River basin in the period since the post-communist political and economic system transformation, including the period after Poland's accession to the European Union. The Oder River basin, with an area of 124,000 km2, is the second largest basin in the Baltic Sea Basin, and therefore requires particular protection. It was emphasised that in the years 1989-2017, water withdrawal for production purposes considerably decreased (by 42%), as well as water withdrawal for exploitation of the water supply system (by 33%). The amount of sewage discharged to rivers was also reduced (by approximately 50%), and treatment technologies considerably improved. Changes in water and sewage management were presented in spatial form, i.e. by hydrographic regions of the Oder River basin. Particular attention was paid to changes in sewage management in cities. They involved among others the liquidation of mechanical treatment plants and a considerable increase in the number of cities with treatment plants with increased nutrient removal. The analysis of the effect of the changes in water and sewage management on the quality of the Oder River and Baltic Sea was also performed, and the rate of decrease in loads of contaminants most harmful to water ecosystems was determined. The role of European Union funds and national funds in the implementation of investments in the scope of water management was emphasised. Finally, attention was drawn to the need to intensify works for protecting waters in agricultural areas, which currently constitute the primary threat to their quality. Several top-priority tasks were also specified that should be implemented in the near future for the purpose of obtaining a good ecological state of waters in the Oder River basin pursuant to the Water Framework Directive.