Rapid urbanization and climate variability reshape the hydrological cycles of urban ecosystems, creating conditions that can amplify the spread of vector-borne diseases such as dengue. In Indian megacities like Bengaluru, where impermeable surfaces and water retention contribute to seasonal vector proliferation, current strategies for mosquito control remain fragmented and reactive. The aim of this perspective is to explore how the current water management practices can be used to support ecological restoration and vector control, thereby reducing the risk of mosquito-borne diseases in wetland environments. To address this, this perspective proposes an integrated framework that applies One Health principles to operationalize Nature-based Solutions for reducing mosquito vector proliferation and improving water management in cities. We outline four key contributions: (1) principles of Water Sensitive Urban Design in Sponge Cities for mitigating vector habitats, (2) insights into urban water management and dengue ecology at Bengaluru’s Jakkur Lake site, (3) a case study as a model for operationalizing Nature-based Solutions, and (4) a roadmap for implementing a One Health approach that integrates human, urban, and broader ecological health.