Sectorial approach for monitoring heavy metal pollution in rivers has failed to report realistic pollution status and associated ecological and human health risks. The increasing spread of heavy metals from different sources and emerging risks to human and environmental health call for reexamining heavy metal pollution monitoring frameworks. Also, the sources, spread, and load of heavy metals in the environment have changed significantly over time, requiring consequent modification in the monitoring frameworks. Therefore, studies on heavy metal monitoring in rivers conducted in the last decade were evaluated for experimental designs, research frameworks, and data presentations. Most studies (∼99%) (i) lacked inclusiveness of all environmental compartments; (ii) focused on "one pollutant -one/two compartment" or sometimes "one pollutant -one compartment -one effect" approach; and (iii) remained "data-rich but information poor." An ecological approach with integrative system thinking is proposed to develop a holistic approach for monitoring river pollution. It is visualized that heavy metal monitoring, risk analyses, and water management must incorporate tracking pollutants in different environmental compartments of a river (water, sediment, and floodplain/bank soil) and consider correlating it with riverbank land use. The systemsbased pollution monitoring and assessment studies will reveal the critical factors that drive heavy metals pollutant movement in ecosystems and associated potential risks to the environment, wildlife, and humans. Also, water quality and pollution indexing tools would help better communicate complex pollution data and associated risks among all stakeholders. Therefore, integrating systems approaches in scientific-and policy-based tools would help sustainably manage the health of rivers, wildlife, and humans.