In order for ISTCs to have a greater impact globally, more ISTCs need to be formed, which is the goal of expansion phase. This includes the process of reaching out to new potential sites and initiating contact. The consolidation phase, which supports sustainability, includes maintaining partnerships through a continued presence. This is the phase most ISTCs are currently in. Sites should be revisited, so that there is assurance that new techniques, surgical education programs, and other interventions have been sustained, and so that relationships are strengthened. Vital to consolidation phase and the sustainability of ISTCs is the process of training the trainers – involving local stakeholders to create future plans for expansion of ISTCs to other institutions in the country as well as to more rural regions. This increases capacity for “south-south” partnerships between LMICs as well. See Fig. 2.