Access to safe and sustainable blood supply system is necessary for a well-functioning healthcare system. Countries worldwide face challenges in providing sustainable blood supply system. The burden is more pronounced for the developing countries particularly Sub Saharan Africa countries where there is a shortfall of 40 million units each year (Bates et al, 2008). Tanzania is one of several countries with the lowest blood donation rates worldwide, receiving less than five donations per 1000 people (Schantz-Dunn & Nawal, 2011). This study was aimed at determining the barriers to sustainable blood availability in Urban Moshi, roles of different stakeholders and evaluating policy issues in place concerning blood availability. Methodology: This was a qualitative case study conducted between 30th May and 24th June 2016, involving key stakeholders from Urban Moshi. Face to face interview was used to obtain information. Literature search from the internet was also used. Data was analyzed thematically. Results: A number of stakeholders were involved in addressing the issue of blood availability. Common barriers were found to be inadequate funds and poor resource allocation in blood bank infrastructure and blood donation programs. Social-cultural misconceptions and religious beliefs also reduced the willingness of community members to donate blood. Furthermore most people who did not donate were not educated on blood donation, blood safety and its importance in saving lives. Those who donated were either knowledgeable on donation, and or had a sick relative and were required to donate for them. Conclusion and recommendation: In order to combat the problem of blood shortage and ensure a sustainable blood supply system in Urban Moshi, there is a need for a multi-sectorial approach. Improved political will, ensuring adequate healthcare infrastructure and overcoming social cultural and religious misconceptions towards blood donation and blood safety will reduce the problem significantly. Policy recommendations are aiming at decreasing inappropriate blood use, educating and sensitizing community, maintain the blood reserves, and increase international aid. These will help to combat the problem of blood shortage in Urban Moshi if they are to be effectively implemented.