Teaching presence is crucial for course organisation, facilitation, cohesion and students’ learning. This study investigates perceptions of teaching presence (TP) among instructors and students in two blended learning (BL) courses at a medical university in Tanzania. BL in these courses included faceto-face lectures, laboratory practical, question and answer teaching approach, team-based learning (TBL), online and offline group discussions, SMS chatting, WhatsApp groups learning, and online examinations via e-learning system. The study employed mixed-methods research design in which quantitative and qualitative data were collected concurrently. Quantitative data include reported scores of students regarding teaching presence measured by the Community of Inquiry Survey (CoI) while qualitative data comprise individual interviews and focus-group-discussion (FGD) transcripts on students and instructors’ perceptions of TP in BL courses. The study is significant as it is the first to have examined students and instructor’s perceptions of TP in a medical college in Tanzania where BL practice is undergoing reformation. Data were analysed using descriptive statistics and content analysis. The study involved two instructors and 144 medical students. Majority of students were aged 20-27, with the males being 62% and 33% females. The findings show that both instructors expressed the course structure and organisation as an important teaching element which is related to the understanding of the course. Instructors exerted their teaching presence through questioning, lecturing, posting materials online, group discussions, and TBL. Instructors described themselves as facilitators, lecturers, guides, demonstrators and questioners. Diagnostics of student learning in BL courses and feedback were done through TBL, multiple-choice questions, and lab practices. Students reported a 3.9 mean score on the instructors teaching presence. Male students reported a high but non-significant mean rank of TP compared to that of female students. Also, first-year students reported high but non-significant TP mean rank scores compared to second years students. Findings revealed that students described their instructors as facilitators, guides, questioner, counsellors, competent, heart softening, inspiring and interactive. Students preferred active learning classes which involved questioning, TBL, group discussions, and exploration. Students perceptions of instructor’s TP matched with those of instructors. However, instructors approached teaching differently depending on the size of the class and their perceptions of teaching. This study implies that teaching presence affects students sense of belonging in the learning, how they interact and how they participate and approach their learning in BL courses.