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NASMS/YOC/MED/SYN5/36/20

REPORT OF THE VISITATION TO NIGERIAN ARMY DRUG

MANUFACTURING COMPANY (NADMACO) AND 68 NIGERIAN
ARMY REFERENCE HOSPITAL YABA (68NARHY) BY STUDENTS OF
YOUNG OFFICERS’ COURSE (MED) 36/20 ON 19 OCT 20

INTRODUCTION

1. Nigerian Army Medical Corps is a combat serve support arm of the

Nigerian Army. It provides rapid and quick medical care to personnel of the
Nigerian Army in other to have a functional and healthy force. To achieve
the Corp mission and purpose the need for quality and potent medications
for the treatment of Army personnel, their families and other Armed Forces
personnel is very important. This cognizant need led to the establishment
of Nigerian Army Small Scale Drug Manufacturing Company (NASDMU) in
1994. This was later to become Nigerian Army Drug Manufacturing
Company Limited (NADMACO). In 1998 the company started the
production of drugs initially producing 760 million tablets and 80 million
capsules per annum. NADMACO Ltd is fully registered with a number of
regulatory bodies some of which includes, the National Agency for Food,
Drug Administration and Control (NAFDAC), Pharmacy Council of Nigeria
(PCN) and the Pharmaceutical Manufacturers Group of Manufacturers
Association of Nigeria (PMG-MAN).

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2. The history of 68 NARHY can be traced to the days of Nigerian Civil

War in 1968. The Hospital which would be later known as 68 Nigerian
Army Reference Hospital Yaba (68 NARHY) was established for delivery of
health care to the Nigerian Army personnel. The Civil war resulted in a
large number of casualties and led to the rapid action to establish a Base
Hospital to provide care for the wounded soldiers at the war front. The
hospital was initially located at Ebute Meta area of Lagos, but, was later
moved to its present location in Yaba due to inadequate space. After the
war, the hospital changed nomenclature to 68 Nigerian Army Reference
Hospital. The hospital provides a wide range of services, both in-patient
and out-patient services including specialist care at cost-effective rates
compared to other hospitals in its environs. It also serves as a referral
center to Nigerian Army Health Facilities, other sister services and the
civilian populace.

3. The Young Officers’ Course 36/20 visited NADMACO and 68 NARHY for
a guided tour of the facilities. This visit was programmed to broaden the
knowledge of the students of YOC 36/20 and improve their managerial
skills. The theme of the visit was “………….”. The purpose of this paper is to
present a report on the educational visit of YOC (Med) 36/20 to NADMACO
and 68 NARHY. The report will covers the historical background of the
facilities, organizational structure, and guided tour of the facilities,
challenges, achievements and recommendations. It is assumed that the
reader is familiar with these NA institutions and the paper will be limited to
information available to us in the course of the visit.

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AIM
1. The aim of this paper is to present a report on the educational visit of
students of YOC 36/20 to NADMACO and 68NARHY with a view to making
recommendations.

AN OVERVIEW OF NIGERIAN ARMY DRUG MANUFACTURING

COMPANY AND ITS RESPONSIBILITIES
2. The establishment of NADMACO was borne out of provision of effective
and efficient healthcare delivery to the personnel of the Armed Forces of
Nigeria. The overview of NADMACO shall cover the following:
a. Drug Manufacturing Facility of NADMACO. The drug
manufacturing facilities of NADMACO are divided into 4 departments.
The departments visited during the guided tour of the facility
includes:

(1) Production Department.

(a) Blending Machine.
(b) Fluidized Bed Dryer.
(c ) Tableting Machine.
(d) Encapsulation.
(e) Blistering.

(2) Quality Assurance.

(a) Instrumentation.
(b) Physicochemical properties.
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(c) Fume Chamber and Oven.

(d) Primary and Secondary Water Treatment:
i. Bore Hole.
ii. Water Tank.
iii. Oxidation Tank.
iv. Filter Beds.
v. Filter Media.

(3) Stores.
(a) Raw Materials
(b) Packaging Materials
(c) Finished Products.
(d) Cold Store.

(4) Maintenance.
(a) Maintenance/Repair workshop.
(b) Electrical Power Generation.
(c) Boiler/Steam Generation.
(d) Water Generation and Purification

b. NADMACO Products Range.

NADMACO Company started operation with four product lines but
had expanded to 18.
NADMACO products range includes the manufacture of the following
quality medicines:

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(1) Tab Nacemol (Paracetamol 500mg)

(2) Tab Nasmoprin (Aspirin 300mg)
(3) Tab Nasmoquine (Chloroquine 200mg)
(4) Tab Nabco (Vit B Complex)
(5) Tab Navic (Vitamin C 100mg)
(6) Tab Navic (Vitamin C 100mg) Chewable white
(7) Tab Naramin (Chlorpheniramine 4mg)
(8) Tab Nadazole (Metronidazole 200mg)
(9) Tab Nacotrim (Co-Trimoxazole 480mg)
(10) Tab Namlodipine (Amlodipine 5mg)
(11) Tab Nartel (Artemether/Lumefantrin 240mg)
(12) Tab Nasrin (Aspirin 75mg)
(13) Susp Nartel (Artemether/Lumefantrin25mg/60ml)
(14) Tab Namoxyclav (Amoxicillin/Clavulanic Acid)625mg
(15) Caps Nampiclox (Ampicillin/Cloxacillin 500mg)
(16) Caps Namox (Amoxicillin 250mg)
(17) Caps Nampicillin (Ampicillin 250mg)
(18) Caps Nacycline (Tetracycline 250mg)
(19) Caps Namphenicol (Chloramphenicol 250mg)

c. Research and Development. The organization is involved

in Research and Development of newer products. The Company has
been able to progressively substitute expensive excipients with
materials that can be sourced cheaply and locally without
compromising the therapeutic efficacy of the finished products. For

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example; Aerosil and pre-gelatinized starch which are imported and

expensive have been successfully substituted with gelatin and starch
which are cheap and readily available.

d. New Products Development. The development of new

products is inevitable for the survival growth of any organization. The
Company has developed Artemisinine Combination Therapy powder
for reconstitution used in the treatment of malaria in children. Other
products that have reached advanced stages of development include
Ciprofloxacin, Erythromycin, NA bottled water and Metformin, to be
known as NAPROCIN, NATROCIN, NATFORMIN and NAQUA
respectively.

e. Covid-19 Response. The ravages of Covid-19 Diseases from

December 2019 had led to the production of hand sanitizer by the
Company. In an effort to support the national strategy of containment of
this infection, the production of the sanitizers followed the World Health
Organizations’ (WHO) standard and had helped Nigerian troops everywhere
they are.3

HUMAN RESOURCE DEVELOPMENT

6. It is a mandatory requirement of the regulatory authorities that
training in a pharmaceutical manufacturing outfit must be continuous.
Production and Quality Assurance Staff are sent to attend paid courses.
Furthermore, step down training are done in-house on various aspects of
production and quality assurance on completion of the courses.

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7. Notably, NADMACO has been identified as a center that can impact

practical hands-on training to National Youth Service Corps (NYSC)
members and students on industrial training under the Students Industrial
Work Experience Scheme (SIWES) of Industrial Training Fund (ITF). In this
regard, both categories of trainees are sent here on a regular basis to
enhance capacity building.

STRATEGIC IMPORTANCE OF NIGERIAN ARMY DRUG

MANUFACTURING COMPANY TO THE NIGERIAN ARMY AND
LIKELY CHALLENGES
8. Armies all over the world are designed to be self-sustaining.
NADMACO fits in strategically to play the key role of making the NA self
sufficient in drugs production. The burden of communicable and non-
communicable diseases in developing regions of the world, no doubt, is
high. The developed countries donate the bulk of medicines used in the
treatment of these diseases. It has also been shown that donor-fatigue is
setting in on these donor countries. For instant, the joint partnership
between USDoD and NMoD which established the Emergency Plan
Implementation Committee (EPIC) to mitigate the scourge of HIV/AIDS
among armed forces personnel is now NMoD Health Implementation Plan
(MoD-HIP). This is because the US Government has scaled down its
partnership due to fatigue. NADMACO can be repositioned with adequate
funds and technology to locally produce most of these medicines such as
antimalarials, antiretovirals etc.

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CONTRIBUTIONS OF NIGERIAN ARMY DRUG MANUFACTURING

COMPANY TO THE OVERALL NIGERIAN HEALTHCARE SECTOR
WITH SEPCIAL REFERENCE TO NATIONAL HEALTH INSURANCE
SCHEME
9. In any healthcare setting, medicines and other consumables
contribute greatly to the overall budget outlay. The cost of healthcare is
reduced drastically when genuine drugs are dispensed on prescription.
Simple infections can develop complications if fake or substandard drugs
are given. It is on this basis that NADMACO has continually entered into
contract with DHML to produce and supply quality medicines to armed
forces personnel and their families under NHIS. The Company has so far
achieved this aim and is sustaining it.

ACHIEVEMENTS
10. Over the years, NADMACO has made tremendous achievements from
its initial installed capacity which is now thrice and also its increase in

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production line as well as increase in number of products are evident. The

achievements of NADMACO include the following:

a. Successful Continuous Supply of NHIS Drugs. NADMACO

Ltd has over the years been consistent in the supply of NHIS drugs to
the 94 NA healthcare Centres and is determined to maintain this. The
Company also has on her supply list, the erstwhile Subsidy
Reinvestment and Empowerment Project (SURE-P), the Department
of State Security, Nigerian Immigration Service, Niger State
government and the general public.

b. Development and Production of First Aid Kit. In 2016,

NADMACO developed and produced a First Aid Kit. These Kits were
procured by the COAS and distributed to own troops in Operation
Lafiya Dole. Reports from the field indicate that KIA from WIA has
drastically reduced, as bleeding from GSWs are now controlled by the
application of these kits.

c. Purchase of Air Compressor Machine. Most machines in

the factory work with compressed air. The Company recently
acquired a new one and planning to buy another as a backup.

d. General Renovation of the Factory. NADMACO is presently

undergoing renovation. Leaking roofs have been replaced, general
paintings are completed and air-conditioners are refurbished.
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e. Purchase of Heating Ventilating Air Condition and De-

humidifier (HVAC). In the second quarter of 2017, NADMACO
was able to purchase HVAC which were delivered to the Company
and installed. The HVAC unit serves to purify the air especially in the
section for production of B lactam antibiotics.
g. Merit Award. As a result of the Company turning out quality
drugs, the Company has been recognized by various regulatory
agencies and given several awards. Among which are:

(1) “Best Entrepreneur Award” under the Small and Medium

Enterprises Equity Investment Scheme (SMEEIS) 2004.

(2) Outstanding Collaboration Award from University of

Ibadan for contribution in training students of the university
under the students Industrial Work Experience Scheme
(SIWES) 2010.

(3) Good Manufacturing Practice Certificate from NAFDAC on

Nartel.

(4) African Quality Achievement Awards 2015. Nacemol,

which is the brand of Paracetamol from NADMACO was
adjudged Africa’s Best Quality Paracetamol Brand of the year
2015.
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h. Corporate Social Responsibilities. As enshrined in the

Constitution of Nigeria, 1999 (Amended); NADMACO, in addition to being a
training ground, has carried out several cooperate social responsibilities
(CSR) to its immediate environment. These CSR include employment of
soldiers’ wives, children and relatives, selling of prescribed over the counter
drugs to officers, soldiers and their families at very marginal cost, as well as
production of portable water for the immediate environment, just to
mention a few.

CHALLENGES
11. There is no pharmaceutical company without its problems and
challenges in the course of production; likewise, NADMACO is not an
exemption to these. NADMACO is confronted with the following problems
and challenges:

a. Inability to Directly Source Raw Materials. One of the

major problems militating against huge profit for NADMACO Ltd is her
inability to completely import her raw materials due to insufficient
capital base. Until this is achieved, a Company like NADMACO that
insists on producing high quality drugs irrespective of the odds has
no option but to contend with the ridiculously low prices sub-
standard drugs are sold in the Country. The only way forward, is to
cut-off middlemen through the direct importation of raw materials

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b. Ageing Equipment. Since the inception of NADMACO in

1994, most of the machines have not been replaced. These machines
are ageing, getting obsolete and are characterized by incessant
breakdown.
c. Power. Though there has been about 15% improvement in
government power supply, the need for regular public power supply
to run our many machines cannot be over emphasized. The Company
is doing its utmost to get around this problem with its 2 generating
plants; at the same time sourcing for the BoDs approved fund to
connect it to the Eleke Crescent supply line.

d. Chaotic Drugs Distribution Channels. Despite appreciable

NAFDAC enforcement efforts, the network of drugs distribution in
Nigeria is still chaotic and unorganized. The result is the sale of
cheap, substandard and adulterated drugs. The ultimate losers are
local manufacturers like NADMACO.

HISTORICAL BACKGROUND OF 68 NARHY

12. The 68 NARHY was established in the year 1968 at the Sabo - Yaba
axis of Lagos. It is situated in Myhoung Barracks on a large space of land
with prefabricated and dilapidated structures scattered all over the
barracks. It was established to cater for a wide range of health need of
Military personnel and also civilian populace. It is one of the pioneer health
facility in the military and serves as a referral centre to Army health
facilities.
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13. However, a lot of renovations and reconstruction have taken place in

the facility in recent times; giving the facility a new and modern look.
Among the new structures are the pharmacy department, DRF, NAPEX, Eye
Centre, MP and Intelligence building, Nutrition/Dietetics and Dental centre
giving way to modern and permanent structures. This has greatly
enhanced the status of the hospital.

ORGANIZATION OF 68 NARHY
14. The hospital is organized into Administrative and Clinical Services
departments. The hospital is headed by a Chief Medical Director which is
normally a Major General’s appointment. He is the head of the
management team and ably assisted by other administrative staff. He
oversees both the administrative and clinical services of the hospital. The
chief clinician heads the clinical services and ensures the day to day
running of the clinical services and reports to the CMD directly. The
hospital staff is made up of Officers and Men of the NA, Ministry of Defence
Staff, Temporary staff (including consultants) and Interns. The main source
of funding for the hospital is from NHIS by way of capitations paid through
Defence Health Maintenance Limited (DHML). However, these funds from
DHML are irregular and hardly enough to run the hospital effectively.

GUIDED TOUR OF THE FACILITIES OF 68 NARHY

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15. A guided tour of the facility was then undertaken ably led by the
Administrative officer. The hospital plays hosts to specialized departments
which were visited. The departments include:
a. Surgery.
b. Ear, Nose and Throat.
c. Obstetrics and Gynaecology.
d. Internal Medicine.
e. Paediatrics.
f. Dental.
g. Eye Clinic.
h. Pharmacy.
i. Nursing.
j. Health Information Management.
k. Physiotherapy.
l. Public Health.
m. Pathology.
n. Radio diagnosis and Dietetics.

16. The pathology department is equipped with the latest diagnostic

equipment including a molecular laboratory. It hosts one of the few centres
that carries out CD4 count and HIV Viral load in the country. Other
available investigations are Gene Xpert, wide range of hematological,
chemistry and microbiological tests. The center has corroboration with the
African Cohort Study.

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17. Also, the wards are mostly new wards with modern facilities. The
wards visited include: male and female (medical), male and female
(surgical) and orthopaedic wards.

18. In addition, notable is the accident and emergency department

located close to the entrance of the hospital and serves as the point of
entry for emergency cases into the hospital services. It is a 16 bedded
ward with facilities for resuscitation and management of trauma,
emergency surgical and medical cases.

19. The dental department is one of the newly constructed facilities in

the hospital. It is equipped with state of the art dental equipment and
boasts of becoming one of the best equipped dental centre in the country
when eventually commissioned.

20. The Heath information management department is the first point of

contact of the patients before accesing medical care. It presently functions
as just a health record as facilities for health information and management
are not yet in place.

CHALLENGES OF 68 NARHY
21. The challenges faced by the facility are listed below:
a. Shortage of Manpower. The shortage of manpower was
identified as a major challenge being faced in the hospital and this

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spans the entire departments. The hospital has few officers and men
to cater for the large number of patients that visit the facility.
b. Funds. Another challenge is the lack of sufficient funding for
the hospital. Capitation payment from DHML is not regular and when
paid it is not enough to run the hospital.

c. Unsteady Power Supply. The lack of steady power supply

from the national grid has compelled the facility to depend on
alternative sources of power e.g. generator.

ACHIEVEMENTS OF 68 NARHY
22. Despite the challenges faced by the hospital, it has thrived in some
areas which make it a reference point in terms of quality health care
delivery. The following are the achievements recorded by the hospital:
a. Achievement of a 5 star status by the laboratory during the
assessment by Strengthening Laboratory Management Towards
Accreditation (SLAMATA) and African Society for Laboratory Medicine
(ASLM).
b. Maintenance of environment.
c. Construction of new building facilities for Nigerian Army College
of Nursing.
d. Construction of modern dental, eye clinic and pharmacy
facilities.

CONCLUSION
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23. NADMACO has great potential for the future as a source of high quality
drugs with great capability of insulating NA personnel from the scourge of
fake and adulterated drugs. The outfit is also an avenue for achieving the
desired professionalism in the NA and harnessing the abundant local natural
resources for drugs production, research and development for the overall
benefit of mankind. It is however being faced with the problems of obsolete
and ageing equipment which requires immediate replacement with modern
ones. (Para 8, 9, 11).

24. The 68NARHY is one of the pioneer referral hospitals in Lagos but still
faces challenges such as, shortage of manpower which is a very pivotal
issue. Others are delay in payment of capitation and unsteady power supply.
The hospital has however despite all odds been able to carry out the
specialist health care delivery it was designed to carry out. (Para 2, 21)

RECOMMENDATION
25. The recommendations shall be at three levels:
a. AHQ
(1) Should make urgent provisions for the procurement of
modern facilities to replace the ageing and obsolete ones in
NADMACO. (Para 23).
(2) Should arrange with the power holding company of Nigeria
to connect NADMACO to a reliable national grid for adequate and
constant power supply. (Para 23).
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b. NAMC

(1) Should in collaboration with ministry of defense equip 68

NARHY with manpower. (Para 24).

(2) Should in collaboration with AHQ increase the capitation

to 68NARHY. (Para 24).

NASMS/YOC/MED/025/36/20
OJO TA AYODELE
Oct 20 Syndicate leader

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REFERENCES
1. Paper presentation by the Ag Managing Director of NADMACO to
students of YOC (MED) 36/20.
2. Brief by the Chief medical director of 68 NARHY to the students of YOC
(MED) 36/20.
3. https://www.pulse.ng/news/local/army-drugs-producing-firm-contributes-
to-coronavirus-war-md/x8h134r retireved Oct 20
4.

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