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.
