Open educational resources (OER) are gaining ascendancy in education, particularly in higher education. Logic suggests that the potential benefits of OER are likely to be greatest in resource-poor contexts such as Africa. However, little is known about the feasibility and sustainability of their use in African institutions. In the Health OER Inter-Institutional Project, OER Africa and the University of Michigan collaborated with medical schools in Ghana and South Africa to help develop OER and tools for facilitating the integration of these into the existing curricula. The article draws upon data from the various evaluations of this project as a basis for generating understandings on initiating and sustaining OER in African contexts. (Contains 6 tables.)