SWOT analysis as a tool for identifying internal and external weaknesses in the context of antimicrobial resistance

Abstract

Introduction. SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis is a strategic tool for assessing the capacity of health systems and public policies to prevent and manage antimicrobial resistance (AMR). It enables identification of internal factors— strengths and weaknesses—and external determinants—opportunities and threats—that shape AMR control. In low- and middle-income countries (LMICs), where antibiotic regulation is limited, diagnostic infrastructure is insufficient, and infection control capacities remain constrained, SWOT analysis supports evidence-based planning. It also highlights opportunities such as expanding rapid diagnostics, strengthening WHO initiatives, and integrating One Health, alongside threats related to health crises and informal antimicrobial markets with substandard products driving irrational use and resistance (Ehsan, 2025). Purpose of the study. To perform a SWOT-based assessment of the Moldovan health system and policy framework for AMR prevention and management, emphasizing internal weaknesses relevant to LMICs. Material and methods. An in-depth interview study was conducted among Public Health and General Medicine specialists (n=109). SWOT analysis was used to assess healthcare professionals’ perceptions of AMR management. Data were collected online in spring 2025 via Google Forms, ensuring confidentiality. Responses were stratified by professional experience, specialty, and involvement in antimicrobial stewardship activities. A Likert scale (0-5) was used, and ordinal data were analyzed by mean scores. Data were processed in MS Excel and SPSS (licensed version). Results. AMR determinants remain critical for LMICs, revealing systemic weaknesses in rational antibiotic use. Differences in Weaknesses perceptions were observed between clinicians and public health physicians. Moderate discrepancies were identified for: (1) easy access and weak regulation of antibiotics (3.08 vs. 3.43); (2) over-the-counter use (2.94 vs. 3.51); (3) excessive/inappropriate prescribing (3.46 vs. 3.80); and (4) incorrect selection and prescribing (3.23 vs. 3.65). These findings indicate the need for interdisciplinary policy harmonization. No substantial variation appeared for: (5) low public knowledge (3.91 vs. 3.93), (6) insufficient health education (3.73 vs. 3.96), and (7) limited antibiotic availability (2.77 vs. 2.85). Conclusions. The study highlighted internal system vulnerabilities and differences in professional perspectives by specialty, experience, and role. SWOT analysis proved valuable for LMICs, offering a practical framework for identifying weaknesses and guiding strategic AMR interventions.