Blood transfusion has become an integral part of modern health care. When it is required, it is an essential element of therapy. However, it is not without risk. Being of human tissue origin, this risk is related to its source as well as the process involved in its provision. To ensure that blood transfusion is safe and does not cause harm to patients, these risks have to be monitored, evaluated and managed appropriately. Therefore, it is essential to develop quality management system to ensure processes and procedures are controlled to prevent deviations and errors. Quality systems should be developed covering the whole transfusion chain. Policies, standards and guidelines are important tools. To ensure that the system is effective, there are various mechanisms to monitor, evaluate and analyse to bring about improvement. These include developing indicators, quality and clinical/transfusion audits, quality assessment programmes and haemovigilance programme. Guidelines whether national or international are required against which practices and performance are gauged. Haemovigilance sometimes lead to focused audits to understand deviations that occurred and to institute corrective actions. In resource limited economies, monitoring can be used effectively when a stepwise approach is adopted. The aim is to create a culture of professionalism in delivering quality of care to patient with efficient use of available resources. The benefit can be extended to influence change and improvement in health care in general. The Hospital Transfusion Committee plays an important role in implementing change.