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This paper reports on a case study of a Health Open Educational Resources (OER) project in order to examine how to facilitate cross-institutional collaboration for OER production. This study assesses collaboration needs, identifies social and technical barriers, and builds a collaboration model to facilitate OER production. In doing so, we make three contributions to the GROUP community: (1) Whereas previous studies on distributed collaboration tend to focus on well-developed collaboration, in this study we research collaboration in Health OER at an early stage of development; (2) By studying collaboration involving both developing and developed countries, we identify components that are particularly critical for collaboration between teams spanning differently resourced nations; (3) By studying the Health OER project, we better understand factors that affect distributed collaboration when participants are not externally funded and are constrained by their local organizations.