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Introduction

Contents

About Bettercare

Bettercare is a South African independent, registered Non-Profit and Public Benefit Organisation launched in 2016. Our aim is to create appropriate, cheap, on-site learning opportunities, without the need for formal tutors, to a wide range of healthcare workers with the goal of improving the quality of healthcare in even the most challenging circumstances.

Bettercare learning courses ensure that all healthcare professionals have access to high-quality, affordable and up-to-date training in every facility, regardless of its history, resources or geographical location. Additions and changes are informed by evidence-based literature and national protocols as well as ongoing feedback from healthcare workers, educators and participants. Learning material is based on new and better methods of diagnosing and treating patients and the latest developments in a wide range of healthcare topics.

Bettercare learning courses grew out of the work of the Perinatal Education Programme (PEP). PEP began in 1989 when a small team of paediatricians, obstetricians and nurses came together to develop a consensus document on best practice care for mothers and infants. The innovative PEP method of self-directed, decentralised learning has been tested in controlled studies and proven to improve knowledge and understanding, attitudes, clinical skills and patient care practices in health professionals. Over 100 000 participants have successfully completed PEP courses.

Currently there are 28 Bettercare courses developed together with experts in their clinical fields. In addition to the paper-based course books, Bettercare courses are also presented on an open-access website.

Why decentralised learning?

Continuing education for health professionals traditionally consists of courses and workshops run by formal trainers at large central hospitals. These courses are expensive, often far away from the health professionals’ families and places of work, and the content frequently fails to address the biggest healthcare challenges of poor, rural communities.

PEP developed the self-help, decentralised learning method in response to these problems and to address the needs of all professional healthcare workers, especially those in under-resourced regions. All Bettercare learning courses follow this basic, proven learning methodology.

A learning course is the curriculum and study material you need to run a course, all in one book. Whether you lead a study group or manage formal training, Bettercare learning courses make your job simpler and easier. We provide the learning material, you run the course. You can implement Bettercare learning courses in your institution right now. There is no need to wait for acceptance to a centralised training programme.

Each chapter of a Bettercare learning course contains the most relevant and up-to-date information health professionals rely on to provide excellent and appropriate care to their patients. Learning material is presented in a problem-solving question-and-answer format. Each chapter has a multiple-choice quiz consisting of 10 to 20 questions. Participants do the quiz before they study a chapter to identify gaps in their knowledge. Afterwards they repeat the quiz to gauge their learning at the end of each chapter. By marking their own quizzes when they complete a chapter, participants monitor their progress through the course.

Participants study one chapter at a time on their own and then meet colleagues in a study group to discuss what they have learned. The formation of study groups encourages co-operative learning where colleagues share their knowledge and understanding. While the role of a facilitator can be useful, a formal teacher is not needed.

Bettercare learning courses have helped thousands of nurses, midwives, doctors, community healthcare workers and students increase their knowledge and understanding, boost their confidence, and improve patient care.

Free Bettercare Online Learning Platform

The Bettercare Learning Platform is a free, open-source website that can be used on tablets, computers or smart phones. Using the very effective self-help study methodology, the material on the Learning Platform includes all the learning courses’ full content and the multiple-choice quizzes for each chapter.

Students using Bettercare books can benefit from video clips addressing diag­nosis and management which are attached to some of the chapters on the website. Currently there are about 32 000 visitors to the Bettercare website each month from many developing and developed countries.

You can access the learning platform here: https://bettercare.co.za/learn/

Learning programmes

Adult HIV

Adult HIV covers an introduction to HIV infection, management of HIV-infected adults at primary-care clinics, preparing patients for antiretroviral (ARV) treatment, ARV drugs, starting and maintaining patients on ARV treatment and an approach to the prevention of opportunistic infections. Adult HIV was developed by doctors and nurses with wide experience in the care of adults with HIV, in collaboration with the Desmond Tutu HIV Foundation.

Breast Care

Breast Care was written for nurses and doctors who manage the health needs of women. It covers breast examination, the assessment and management of benign breast conditions, the diagnosis and management of breast cancer, and palliative care. The book is used for training by The Breast Course for Nurses, an NGO established to improve the care of women with breast problems.

Child Healthcare

Child Healthcare addresses all the common and important clinical problems in children, including immunisation, history and exam­ination, growth and nutrition, acute and chronic infections, parasites, skin conditions, and difficulties in the home and society. It was developed by a number of experienced paediatricians and paediatric nurses for use in primary-care settings.

Childhood HIV

Childhood HIV enables nurses and doctors to care for children with HIV infection. It addresses an introduction to HIV in children, the clinical and immunological diagnosis of HIV infection, management of children with antiretroviral treatment, antiretroviral drugs, opportunistic infections and palliative care.

Childhood TB

Childhood TB was written to enable healthcare workers to learn about the primary care of children with tuberculosis. The book covers an introduction to TB infection, and the clinical presentation, diagnosis, management and prevention of tuberculosis in children, and HIV and TB co-infection. Childhood TB was developed in collaboration with the Desmond Tutu Tuberculosis Centre.

Congenital Disorders (previously Birth Defects)

Congenital Disorders was written for healthcare workers who look after individuals with congenital disorders, their families, and women who are at increased risk of giving birth to an infant with a congenital disorder. Special attention is given to modes of inheritance, medical genetic counselling, and congenital disorders due to chromosomal abnormalities, single gene defects, teratogens and multifactorial inheritance. This book is used in the Medical Genetics Education Programme which trains healthcare workers in genetic counselling in South Africa. It is also endorsed by Genetic Alliance SA, a support organisation for families affected by congenital disorders.

Ebola Prevention and Control

Ebola Prevention and Control was written for all healthcare workers and administrators managing, preventing and controlling viral haemorrhagic diseases. Chapters cover virology and epidemiology, patient management, support systems and documentation and communication and community engagement. There is a strong emphasis on the protection of healthcare workers in the field of viral infections, particularly in resource-limited settings.

Fetal Heart Rate Handbook

One of the most dangerous times of our life is the few hours when our mother is in labour. Monitoring the fetal heart rate is the best method of assessing fetal wellbeing in primary care facilities. However appropriate technology to monitor the fetal heart rate in labour is often not available in many labour wards though it is vital to prevent brain damage. The Fetal Heart Rate Handbook teaches the basics of oxygen transfer from mother to fetus and how to monitor the fetus in labour with a fetal stethoscope or preferably with a Doppler ultrasound fetal heart rate monitoring order to recognise inadequate oxygenation.

How to lead a study group: A guide for facilitators

How to lead a study group: A guide for facilitators provides clear guidelines to local facilitators who want to set up a study group and assist colleagues to manage their own continuing education and professional growth. Topics include an introduction to working in groups, how to start, plan and manage a study group, and how to order course books or access the Bettercare learning platform. Managing an end-of-course examination is also discussed. A group leader can function as the facilitator as formal teachers are not needed.

Infection Prevention and Control

Infection Prevention and Control was written for nurses, doctors, and health administrators working in the field of infection prevention and control, particularly in resource-limited settings. It includes chapters on infection prevention and control programmes, risk management, health facility design, outbreak surveillance and antimicrobial stewardship. The book is supported by the Academic Unit for Infection Prevention and Control (UIPC) at Tygerberg Academic Hospital.

Intrapartum Care

Intrapartum Care was developed for doctors and advanced midwives providing care during labour and delivery in level 2 hospitals. It contains theory and skills chapters adapted from the labour chapters of Maternal Care. Particular attention is given to the care of the mother, the management of labour and monitoring the wellbeing of the fetus. Intrapartum Care was written to support and complement the national protocol of intrapartum care and the essential steps to manage obstetric emergencies (ESMOE) in South Africa.

Maternal Care

Maternal Care addresses all the common and important problems that occur during pregnancy, labour, delivery and the puerperium. It covers the antenatal and postnatal care of healthy women with normal pregnancies, monitoring and managing the progress of labour, specific medical problems during pregnancy, labour and the puerperium, family planning and regionalised perinatal care. Skills chapters teach clinical examination in pregnancy and labour, routine screening tests, the use of an antenatal card and partogram, measuring blood pressure, detecting proteinuria and performing and repairing an episiotomy. Maternal Care is aimed at health workers in level 1 hospitals or clinics.

Maternal Mental Health: A guide for health and social workers

Maternal Mental Health was written for doctors, nurses and social workers caring for women before and after birth. It includes an introduction to maternal mental health and illness, making referrals for maternal mental illness, helping mothers with mental health problems and special issues in maternal mental health such as postpartum depression. It includes a resource section for assessing, referring and supporting mothers in the perinatal period. The book is supported by The Perinatal Mental Health Project of the Department of Psychiatry and Mental Health at the University of Cape Town.

Mother and Baby Friendly Care

Mother and Baby Friendly Care describes gentler, kinder, evidence-based ways of caring for women during pregnancy, labour and delivery. It also presents improved methods of providing infant care with an emphasis on kangaroo mother care and exclusive breastfeeding.

Newborn Care

Newborn Care was written for health workers providing special care for newborn infants in level 2 hospitals. It covers resuscitation at birth, assessing infant size and gestational age, routine care and feeding of both normal and high-risk infants, the prevention, diagnosis and management of hypothermia, hypoglycaemia, jaundice, respiratory distress, infection, trauma, bleeding and congenital disorders, as well as communication with parents. Clinical skills chapters address resuscitation, size measurement, history, examination and clinical notes, nasogastric feeds, intravenous infusions, use of incubators, measuring blood glucose concentration, insertion of an umbilical vein catheter, phototherapy, apnoea monitors and oxygen therapy.

Palliative Care for Children

Palliative Care for Children was developed in association with Palliative Treatment for Children in South Africa (PatchSA) to meet the health care needs of children with life threatening and life limiting conditions. Clinical assessment, planning and management are discussed as are the ethical, psychosocial, cultural and spiritual aspects of care. Emphasis is given to compassionate pain management and family support.

Perinatal HIV

Perinatal HIV enables midwives, nurses and doctors to care for pregnant women and their infants in communities where HIV infection is common. Special emphasis has been placed on the preven­tion of mother-to-infant transmission of HIV. It covers the basics of HIV infection and screening, antenatal and intrapartum care of women with HIV infection, care of HIV-exposed newborn infants, and parent counselling.

Perinatal Palliative Care

Perinatal Palliative Care was developed in association with Palliative Care for Children in South Africa (PatchSA) to meet the healthcare needs of babies diagnosed with a life-limiting condition in utero or soon after birth, as well as parents and families. Decision making, planning care and support during the antenatal period, during labour, immediately after delivery, and the post-natal period are discussed. The focus remains on improving quality of life and comfort care for babies not expected to live long and continued support for their families from the time of diagnosis and into the bereavement period.

Primary Maternal Care

Primary Maternal Care addresses the needs of health workers who provide antenatal and postnatal care, but do not conduct deliveries. It is adapted from theory and clinical skills chapters from Maternal Care. This book is ideal for midwives and doctors providing primary maternal care in level 1 district hospitals and clinics, and complements the national protocol of antenatal care and basic antenatal care (BANC) approach in South Africa.

Primary Newborn Care

Primary Newborn Care was written specifically for nurses and doctors who provide primary care for newborn infants in level 1 clinics and hospitals. Primary Newborn Care addresses the care of infants at birth, care of normal infants, care of low-birth-weight infants, neonatal emergencies, and common minor problems in newborn infants.

Public Health

Public Health focuses on the huge need to improve the performance of health facilities and services. Common problems and their causes are identified, workable solutions are given, and methods for monitoring outcome and impact described. Important topics include sources of information, communication, access to health care, measuring and evaluating health problems, environment, nutrition, governance, responding to health risks, finance and procurement, information systems and workforce management.

Saving Mothers and Babies

Saving Mothers and Babies was developed in response to the high maternal and perinatal mortality rates found in most developing countries. Learning material used in this book is based on the results of the annual confidential enquiries into maternal deaths and the Saving Mothers and Saving Babies reports published in South Africa. It addresses the basic principles of mortality audit, maternal mortality, perinatal mortality, managing mortality meetings and ways of reducing maternal and perinatal mortality rates. This book should be used together with the Perinatal Problem Identification Programme (PPIP).

Women’s Health Care (previously Well Women)

Women’s Health Care was written for primary healthcare workers who manage the everyday health needs of women. It covers reproductive health, family planning and infertility, common genital infections, vaginal bleeding, pain and discomfort and the abuse of women.

Format of the courses

Objectives

The learning objectives are clearly stated at the start of each chapter. They help the participant to identify and understand the important lessons to be learned.

Pre- and post-quizzes

There is a multiple-choice quiz of 10 to 20 questions for each chapter at the end of the book. Participants are encouraged to take a pre-quiz before starting each chapter, to benchmark their current knowledge, and a post-quiz after each chapter, to assess what they have learned. Participants are provided with the correct answers so that they can mark their quizzes when they have completed that chapter. The source of each question is given next to the correct answer so participants can reread those sections that have not been mastered. Self-assessment allows participants to monitor their own progress through the course.

Question-and-answer format

Theoretical knowledge is presented in a question-and-answer format, which encourages the learner to actively participate in the learning process. In this way, the participant is led step by step through the definitions, causes, diagnosis, prevention, dangers and management of a particular problem.

Participants should cover the answer for a few minutes with a piece of paper while thinking about the correct reply to each question. This method helps learning.

Each question is identified with the number of the chapter, followed by the number of the question, e.g. 5-23.

Simplified flow diagrams are also used, where necessary, to indicate the correct approach to diagnosing or managing a particular problem.

Important practical lessons are emphasised like this.

Note
Additional, non-essential information is provided for interest and given in notes like this. These facts are not used in the case studies or included in the multiple-choice quizzes.

Case studies

Each chapter closes with a few case studies which encourage the participant to consolidate and apply what was learned in the chapter. These studies give the participant an opportunity to see the problem as it usually presents itself in the clinic or hospital and integrate their new theoretical knowledge into practice. The participant should attempt to answer each question in the case study before reading the correct answer.

Practical skills

Some Bettercare books include workshops on skills that need to be practised, preferably in groups. These skills workshops list essential equipment and present step-by-step instructions on how to perform each task, often with pictures. If participants are not familiar with a practical skill, they should ask an appropriate medical or nursing colleague to demonstrate the clinical skill to them. In this way, senior personnel are encouraged to share their skills with their colleagues. Some of the skills are demonstrated in video clips in our online books.

Bettercare exams

Bettercare has, in the past, offered a final examination for each course. Participants needed to achieve at least 80% in the final examination to receive a digital certificate stating that they have successfully completed the learning course. Due to financial constraints, the exams-on-line can no longer be offered. It is hoped that this service will once again be offered in future.

Managing a course

The online book How to lead a study group: A guide for facilitators gives a step-by-step guide to setting up a self-directed study group.

Contributors

The developers of our learning materials are a multi-disciplinary team of nurses, midwives, obstetricians, neonatologists, general paediatricians and other medical specialists. The development and review of all course material is overseen by our Editor-in-Chief, emeritus Professor David Woods, a previous head of neonatal medicine at the University of Cape Town who consulted to UNICEF and the WHO.

Perinatal Education Trust and Bettercare

The Perinatal Education Trust (PET) was a non-profit organisation which aimed to improve the care of pregnant women and their newborn infants, especially in poor, rural communities. The Perinatal Education Trust produced and distributed all Perinatal Education Programme (PEP) material. Between 1989 and 2015, over 100 000 health workers used PEP course books in South Africa.

Bettercare took over the function of PEP in 2016, when the range of books expanded beyond maternal and newborn care.

Breast Course for Nurses

The Breast Course for Nurses combines distance education with a residential course. The emphasis is on learning rather than teaching. The course can be adapted to suit the needs of the healthcare providers being trained.

Academic Unit for Infection Prevention and Control at Stellenbosch University

The Academic Unit for Infection Prevention and Control (UIPC) is based at Tygerberg Academic Hospital and the Stellenbosch University Faculty of Medicine and Health Sciences (FHMS). It resides under the Division of Community Health and is also a member of the Centre for Infectious Diseases.

The UIPC focuses on integrated research, training and service provision. The unit offers a range of tailor-made courses in Infection Prevention and Control (IPC) as well as decontamination and sterilisation for Sterile Service Departments (SSDs). In addition, courses are offered for specialities such as operating theatres, renal dialysis units, intensive care units and infectious disease management and control.

The Desmond Tutu HIV Foundation

The Desmond Tutu HIV Foundation at the University of Cape Town is a centre of excellence in HIV medicine, building capacity through training and enhancing knowledge through research.

The Desmond Tutu Tuberculosis Centre

The Desmond Tutu Tuberculosis Centre at Stellenbosch University strives to improve the health of vulnerable groups through the education of healthcare workers and community members, and by influencing policy based on research into the epidemiology of childhood tuberculosis, multi-drug-resistant tuberculosis, HIV and TB co-infection, and preventing the spread of TB and HIV in southern Africa.

Perinatal Mental Health Project

The Perinatal Mental Health Project of the Department of Psychiatry and Mental Health at the University of Cape Town aims at improving the mental health of women both during pregnancy and in the months afterwards. The project targets women who are at risk of depression and anxiety.

The Infection Control Africa Network

The Infection Control Africa Network (ICAN) promotes and facilitates the establishment of infection control programmes. This includes promotion of surveillance for and reduction of healthcare-associated infections, and antimicrobial stewardship activities through education. ICAN works with infection prevention structures in Africa and other international health-related associations.

Updating the course material

Bettercare learning programmes are regularly updated to keep up with developments and changes in healthcare protocols. Course participants can make important contributions to the continual improvement of Bettercare books by reporting factual or language errors, by identifying sections that are difficult to understand, and by suggesting additions or improvements to the contents. Details of alternative or better forms of management would be particularly appreciated. Please send any comments or suggestions to the Editor-in-Chief, Professor David Woods.

Contact information

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