Participants reported that there are no central global surgery offices at their institutions, so the efforts are too fragmented and each hospital has its own projects. Participants felt that structure was necessary to create priorities and that it was the institution’s responsibility to implement structure. They expressed that there should be a few flagship projects from each institution with more coordination and focus. “I think if we appointed a head of global health and gave that person some resources and a mandate, then you have a structured global health initiative.” –OB/Gyn, Canada