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Five years of sustained collaboration between a Thai and an Australian university known as the Thai–Australian Health Alliance represents 'a strategic alliance of organised interaction of considerable duration' (Sverrisson, 2001: 313, Haagedorn, 1993). The overall goal of the Alliance is to assist with policy and practice reform in healthcare while its aim is to focus on capacity building and sustainability in rural health service management to foster cross-cultural collaboration and knowledge transfer in this field. This partnership has included participation in a doctoral program in Australia, multidisciplinary, health research projects and curriculum mapping activities in Thailand, educational study tours and student exchanges between the partner organisations, the establishment of a network of participating organisations and the development of a collaborating centre of health management expertise that is currently undergoing designation as a WHO CC. While international partnerships are difficult to sustain (Saffu & Mechanics, 2005), Walt (2005) has identified 1) consensus building and advocacy; 2) cross learning and transfer of knowledge and; 3) production and sharing of international goods as important activities in developing and maintaining successful international health alliances. Austin (2000) describes a three stage continuum of moving from philanthropic to transactional to integrative stages in developing strategic alliances. According to Hurley (2003), there are six key success factors of collaboration which are clear common aims, trust, collaborative leadership, sensitivity to power issues, membership structures and action learning (CIHC …