Biological monitoring programmes have gained popularity around the world particularly in southern Africa as they are fast, integrative and cost-effective approaches for assessing the effects of environmental stressors on aquatic ecosystems. This article reviews current efforts that have been made to use bioindicators (i.e. macroinvertebrates, diatoms and fish) in monitoring water resources and to summarise the challenges in employing these biological monitoring tools in southern Africa. In South Africa, macroinvertebrate (South African Scoring System (SASS)) and diatom based indices (e.g. South African diatom index (SADI)) have demonstrated their utility in identifying sources of impairment and determining the extent of impacts thus giving natural resource managers a scientifically defensible rationale for developing guidelines for conservation and management. Despite this advancement in South Africa, however, developing regionally appropriate quantitative tools for diagnosing ecosystem health is a pressing need for several other southern African countries. Together with sound scientific research, it is imperative for southern African countries to develop specific legislation and have mandated agencies, with proper training and funding to implement biomonitoring and bioassessments. We recommend for the advancement and adoption of biological criteria as an integrated approach to assessing the impact of human activities in riverine ecosystems of the southern African region.