ISTCs often begin with individual efforts, and as mentioned by participants, this can be discouraging since there is no systematic method for involvement and implementation. Individual ISTCs are often done in many different ways, but a more structured approach is needed to globally coordinate efforts [18–21]. This coordination could happen at the national level, through discussions with the Ministry of Health, Ministry of Finance, and healthcare representatives from different regions in the country. This could also involve professional bodies who are monitoring surgical activities in the country or region and can convey information to national governmental bodies. A brief overview of a proposed systematic process is outlined below and in Fig. 2: expansion and consolidation phases.