This paper provides the practical experience of developing an eLearning technology as a tool to implement Competency-based Medical Education (CBME) in Tanzania medical universities, with a specific focus on Muhimbili University of Health and Allied Sciences. The paper provides a background to eLearning and the early attempt to adopt it in 2006 at MUHAS, with its challenges leading to failure. Next it presents the strategic re-establishment of eLearning to support the new CBME introduced in 2009. Finally, the paper discusses the challenges faced during the implementation process and provides a discussion of lessons learnt. The paper suggests that, in order to improve the quality of medical education in settings with limited resources, universities in developing countries should make effective use of innovative and emerging technologies relevant to their environments. Successful implementation of eLearning requires a strategic approach which should involve university management, academic staff and students. The approach should take into account significant issues including pedagogy, ICT infrastructure, appropriate technologies, human resources, eLearning policy, faculty and student training, integration of eLearning and information literacy as well as the university curricula and partnerships.