The School of Medicine at St Andrews has been involved in helping the College of Medicine in Blantyre, Malawi for several years in learning and teaching matters. We are expanding our work there to focus on making a difference on the ground to improve healthcare delivery and outcomes there. The School has been awarded a second follow-up grant from the Scottish Government International Development Fund (SGIDF) on Enhancing Healthcare Training in which the School will now extend the curriculum review and support that it gave to the undergraduate medical programme at the College of Medicine in Blantyre, Malawi to the all its allied healthcare professionals degree programmes. This project will allow the College of Medicine to maximise the effectiveness of its limited staff and teaching resources to all its degree programmes and even introduce new ones to expand the biomedical science training in Malawi. This project involves curriculum planning and delivery through pedagogic and Learning Technology (LT) support from the School of Medicine at St Andrews. This project involves staff and students from St Andrews going to the College of Medicine in Blantyre and working on the ground with staff there. In addition to the curriculum and LT project the School has embarked on a new venture following a significant donation for a Global Health Implementation (GHI) Initiative to support the establishment of a Chair and other supplementary posts in GHI. The main purpose of this initiative is to produce change on the ground in Malawi by looking at ways of researching and implementing policies, procedures and interventions that will improve healthcare outcomes in Malawi. The initial focus will be upon maternal and child health with improved obstetrics training of medical and clinical officers an obvious first step. This GHI initiative will result in joint appointments of staff between St Andrews and Malawi and so have in effect a St Andrews office in the College of Medicine. The School of Medicine already has a significant research presence in Malawi on a project involving the management of tuberculosis.