Background: Hundreds of international projects are implemented all over the world. Sustainability of such projects is always questioned. The objective of this study was to analyze landmarks of successful collaboration in global surgical issues between Ukrainian and Canadian institutions from 2006 to 2013. Methods: We completed a descriptive analyses of 3 international projects. Results: In collaboration with Ukrainian obstetrics and gynaecology associations and the Society of Obstetricians and Gynecologists of Canada, an initiative seeking to improve emergency obstetrical care using the Advances in Labour and Risk Management International Program (AIP) was conducted in Ukraine. From 2006 to 2009, 912 providers participated in 18 AIP trainings. Since project termination, 10 AIP training with 435 participants were conducted by a national team. Training is now institutionalized into the Donetsk National Medical University (DNMU) curricula. Since 2010 in collaboration between the University of Toronto, and the DNMU, the Donetsk Telesimulation Satellite Center was established. A telesimulation program has been applied to introduce the Fundamentals of Laparoscopic Surgery course, with the objective to standardize the technical skills of Ukrainian professionals. In total, 137 participants from 11 sites have completed the course. Since 2011, a collaboration between the McGill University and the DNMU to improve disaster management and trauma care has been established. A risk assessment tool geared speci fically toward the European Football Championship Euro 2012 was developed. Trauma training has been conducted and the creation of a database of injury epidemiology. Conclusion: Sustainable partnerships is important to ensure long-term interest in an initiative either funded or not. Capacity building based on bottom-up approaches with the initiative coming from national professionals to ensure national ownership and leadership with long-term commitment is essential. 2. COSECSA, achievements and challenges in improving global surgery. P.G. Jani.