 This study found that the total annual costs of running the clinical cost centers at two district hospitals and one regional referral hospital in Arusha region range from $67,000 at Ultramet District Hospital to $453,000 at Mount Meru Regional Referral Hospital. The total costs of surgeries range from $9,000 to $13,000, accounting for 12 percent to 22 percent of the total costs of running the hospitals. Salary costs made up the majority of these costs, with the exception of Mount Meru Regional Referral Hospital where capital costs were higher. The study also found that open reduction and internal fixation, or if, was cheaper than surgical debridement plus conservative treatment due to prolonged post-operative inpatient care associated with the latter. However, this procedure was performed less frequently due to unavailability of implants. The study concluded that lower unit costs and shares of capital costs at the regional hospital reflect an advantage of economies of scale and scope, while greater efficiencies make a case for concentration and scale-up of SURG. This article was authored by Marty Lord Ifianayakai, Hank Broquison, Audine Anjouma, and others.