Access to safe and sustainable blood supply system is necessary for the well functioning of a 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 which have the lowest quantity of blood available per person. Tanzania is one of several countries with the lowest blood donation rates worldwide. This study was aimed at determining the barriers to sustainable blood supply system in Urban Moshi, Impact of blood shortage, role of stakeholders and evaluating policy issues in place concerning blood availability. Methodology: This was a qualitative cross sectional 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 analysed thematically Results: A number of stakeholders were involved in addressing the issue of blood availability. Common barriers were found to be lack of financial support from the government in conducting blood donation programmes and establishing adequate blood bank infrastructure. The lack of willingness of people to donate blood due to social-cultural and religious misconceptions was also an important barrier. Furthermore most people who did not donate were not educated on blood donation and blood safety. 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 multisectorial 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 implemented.