Social presence in a blended learning involves construction of learning through student sharing, interaction and support thus improving students’ motivation, and learning. This paper examines students’ perceptions of social presence (SP) in blended learning courses (BL) in a medical college in Tanzania. Three research questions are addressed: are there significant differences in the reported scores of SP among students based on gender, age and year of study? How is SP encouraged in the BL medical courses? How is SP associated with students’ learning in the BL medical courses? Following a mixed method, Social Presence Scale and Focus Group Discussion were used in data collection. BL in these courses included face-to-face lectures, student online and face-to-face group discussions, laboratory practices, team-based learning (TBL), and online exams. The study involved 144 medical students. Survey results showed no significant differences in the reported scores of SP based on students’ characteristics. However, affective expression and open communication were more valued than group cohesion elements of SP. Qualitative results showed that SP was encouraged through provision of group assignments, teacher online activities, and students’ group discussions. Through SP and interaction, students learnt various concepts and examination questions in both online and in face-to-face discussions. The conclusion is that students’ characteristics were not crucial, however, group discussion and SP influenced their learning.