Global health. The current scenario and future perspectives

253 In Latin American health systems, which, in terms of financing, represent arrangements with different financial sources including specific contributions for health (payroll taxes) as well as general taxes and out-of- pocket payments, the challenges that have been raised are focused on strengthening equity. This would mean increasing public spending on health which would translate into reducing the proportion of out-of-pocket expenditure within total healthcare spending and increasing fiscal expenditure (Titelman et al., 2015). Additionally, addressing these challenges would require developing a financing model that effectively integrates different sources of healthcare financing, namely fiscal contribution from social security and private spending (Titelman et al., 2015). Health expenditure as a percentage of GDP ranges between 5% to just over 9% in Latin American countries but, in most cases, public spending on health is less than 6% of GDP with out-of-pocket expenses reaching up to 43%. While several countries rely on general taxation for funding their systems there are high levels of informal economy, which makes revenue collection difficult (Kanavos et al., 2019). Lessons learned about Covid-19 To be able to address the huge sanitary economic and social impact that Covid-19 has had worldwide the WHO indicated that response strategies should involve early decision-making at national level on public health actions as well as involvement of all sectors (WHO, 2020b). This is in line with the Health in All Policies approach established by the European Union under Finland’s presidency in 2006 (Euro Obs Health Syst Pol, 2006) and later adopted by the WHO (WHO, 2014). This would imply a comprehensive national response that should include public health interventions aimed at breaking the chain of virus transmission among people, identifying cases with their respective isolation, testing and clinical care for those who require it and contact tracing and isolation (quarantine). Additionally, to address different affected areas various sectors and actors should be included in this response (individuals, institutions, communities and local and national governments), each contributing from their specificities to the objective of controlling or stopping community spread of Covid-19 (WHO, 2020c). For example, if sufficient economic subsidies are not provided to vulnerable families so they can have resources to comply with quarantine measures then compliance is lower because family members continue going out to seek daily sustenance (MOVID-19, 2020). In this context, the demand on healthcare systems, especially