 Iverson and colleagues suggest that decentralizing or regionalizing surgical services must take into account contextual realities as well as procedure-related considerations such as volume, patient acuity, and procedure complexity. They argue that these factors should be taken into consideration when determining whether to decentralize or regionalize surgical services. Additionally, they suggest that contextual factors such as travel distance and system-induced delays can be minimized through decentralization while maintaining a workforce with sufficient expertise to offer services safely. Furthermore, they propose that centralization can conserve resources by limiting the number of sites. Finally, they argue that context and procedure-related factors can be combined to create an integrated body of guidance that can be applied to both low- and high-income countries.