This paper describes the conditions of households along the different sections of Pagatban River in Negros Oriental that were categorized as 'downstream', 'midstream' and 'upstream' settlements for analysis, to show how the 'one size fits all' approach to addressing the environmental problems that confronted these households compares to site-specific intervention. The diversity of households in the three settlements in terms of demographic, social and economic characteristics may have been either the results or determinants of the quality of the river, which has been destroyed by continuing mining operations and logging activities in the upstream areas. Such diversity in human settlements and relationships with the river requires site-specific interventions that address distinct problems and priority needs of each settlement.