Based on a qualitative case study in An Giang province, Vietnam, we mapped the understanding of the ‘Living with Floods’ (LWF) concept and the implementation of three projects to explain the effectiveness of water governance in Vietnam. We have demonstrated how perceptions on the LWF concept differ per government level and the limits of water governance effectiveness. Diverging perceptions undermine the effectiveness of water governance. A framework and a list of indicators are proposed to measure the effectiveness of floodwater governance. Integrating local and social aspects in LWF policies and vertical coordination may help align short-term benefits with long-term adaptation.