Once an ISTC has met these goals for a particular site, expansion phase can be repeated. However, repeating expansion phase does not imply termination of relationships that were maintained in consolidation phase, but instead focuses on a comprehensive picture of how more relationships can be formed. These cycles of expansion and consolidation could allow ISTCs to both proliferate in number and be sustainable with long-term successful outcomes. This is essential so that efforts are not only reaching tertiary hospitals, but are also building surgical capacity in rural hospitals and clinics .