Diatoms are of significant ecological importance in aquatic ecosystems, which stems from their dynamic position at the base of the trophic web as primary producers. Because diatom communities have specific environmental requirements and respond rapidly to changes in environmental conditions they are often employed as a cost-effective method to assess anthropogenic impacts and health statuses of aquatic ecosystems, particularly in Europe and North America. The purpose of this review is to summarise the challenges and future prospects associated with biological water quality monitoring using diatoms with special focus on southern Africa. Much work still needs to be carried out on diatom tolerances, ecological preferences and ecophysiology. It is recommended that past research pertaining to African diatom taxonomy should be made readily accessible to all through electronic media for use as a reference point. Moreover, following the same approach as for macroinvertebrate biomonitoring, African and other developing countries can resort to intermediate diatom taxonomy (i.e. genus), which is easier, less time-consuming and requires less-skilled personnel. While the lack of capacity and baseline information on diatom community composition and ecological requirements represent significant hurdles, diatom biomonitoring potentially holds much promise for understanding the ecological functioning and management of aquatic ecosystems in southern Africa. The application of diatom-based water quality assessment protocols has direct and immediate value for use as an 'added-value' assessment tool in addition to the use of macroinvertebrates and fish indices as these can indicate anthropogenically impacted and pristine sites.