River ecosystems are increasingly affected by urban wastewater, hydrological modification, habitat disturbance and competing demands for freshwater resources. Effective river conservation therefore requires an assessment framework that integrates physicochemical water quality, biological responses, biodiversity conservation and wastewater-management performance. The Narmada River, one of the principal river systems of central India, provides an important case for examining these interconnected challenges.

This case study–based critical review synthesises three complementary evidence streams: (i) historical field observations from a two-year investigation of benthic macroinvertebrates and physicochemical parameters at Bargi Dam, Gwarighat and Bhedaghat during November 2015–October 2017, (ii) published research and government reports concerning Narmada River ecology and water quality, and (iii) recent institutional and judicial records relating to river conservation and urban sewage management in Jabalpur. The historical investigation documented 758 benthic macroinvertebrate individuals belonging to 55 families, 18 orders and four phyla. Four biological indices—Saprobic Index, Hilsenhoff Biotic Index, Benthic Index of Biological Integrity and EPT percentage—were used alongside a Water Quality Index to assess ecological condition. The reported results demonstrated spatial variation among sampling locations and non-uniform changes between the two study years.

Recent evidence adds an important management dimension. The Wildlife Institute of India undertook intensive ecological surveys of the Narmada between December 2022 and May 2024 as part of a national river-conservation initiative. Separately, judicial records concerning Jabalpur documented a substantial gap between estimated sewage generation and the quantity treated, alongside proposed sewerage infrastructure expansion. These records identify a need to connect wastewater-treatment performance with direct measurements of receiving-water quality and biological response. The review proposes an integrated river-health framework combining biological monitoring, physicochemical analysis, habitat assessment, wastewater-load accounting and transparent environmental reporting. It argues that infrastructure completion alone cannot demonstrate ecological recovery, improvements must also be verified through receiving-water measurements and standardised biological indicators. The framework may support evidence-based monitoring and conservation planning for the Narmada and other rivers experiencing similar urban and hydrological pressures.