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In response to the rapidly changing occupational health environment, Bangkok DusitMedical Services (BDMS) has recognized a need to increase the quality and availabilityof occupational health services. This manuscript describes the evolution of aninternational health alliance, based on the “twinning” framework, to achieve acollaborative goal of developing an Occupational Health Center of Excellence(COE-OH) in Thailand. Through this alliance, the COE-OH has supported thedevelopment of programs in the areas of health promotion, training and research. Thetwinning framework was applied as the alliance moved through initiation, implementation,monitoring and evaluation. Project evaluation was viewed as an iterative process thatinformed next steps in the process as the collaboration developed. Initial products ofthis alliance include adaptation of the “Let’s Get Healthy!” health promotion and datacollection tool for use as part of the Thai employee check-up; development andimplementation of occupational health trainings for various levels of clinical staff;student exchange opportunities; and the creation of the infrastructure to supportstanding up of a fully human subjects compliant data repository for research. Threeyears into this alliance, the COE-OH has reached a point where feasibility has beenestablished and the immense opportunities of future joint work have become apparent.