DOTOH App

In Benin, the 2018 Demographic Health Survey (DHS) indicates an “epidemic” of unintended teenage pregnancy: 20% of adolescents 15-19 years old gave birth, and the childbearing intention among 15-19 years was estimated at 5.9 children per woman. Only 12% of women of reproductive age use a modern contraceptive method. 

Main sources of sexuality information include the Internet 51 %, 76.6% of respondents have practiced group sex (with at least 2 partners), and 29.7% had occasional partners. According to the UNPFA 2020 Youth and COVID-19 Technical Brief, the COVID-19 pandemic disproportionately affected adolescents and youth. It disrupted access to sexual and reproductive health SRHR, general medicine, and primary care routine health services.

In addition, access to primary care remained limited during and even after the pandemic, due to the lack of availability, accessibility, and affordability of services. The majority of the population can't access quality primary care promptly.

Digital health represents a pandemic-resilient approach to improve access to SRHR, contraception care, and primary care

DOTOH (means health professionals in Fon, the most spoken local language in the Benin Republic) is a mHealth and novel telehealth platform providing sexual and reproductive services SRHR, general family medicine, and primary care. It aims at increasing the uptake of preventive health services for adolescents and young adults. Through a mobile app and its embedded telehealth solution, the platform enables users to use 6 distinct services: 

1) make an appointment with qualified and vetted healthcare professionals, 2) use our telehealth service to connect online by synchronous and asynchronous audio or video call for contraceptive counseling and prescription, maternal and child healthcare, family planning, and general healthcare check-ups.

3) purchase online sexual and reproductive health products and commodities such as condoms, oral contraceptives, lubricants, menstrual products, etc, and other over-the-counter primary care medications

4) access centralized medical records and benefit from referral to partner clinics, 

5) access the geographical location of peripheral clinics and pharmacies 

6) access a complete library of articles covering various subjects related to sexual and reproductive health and primary care. 

The app is currently available in French and English.

The design and testing of such an innovative, friendly, confidential, culturally tailored, and integrated platform was led by the Young Beninese Leaders Association (YBLA) and supported by a cohort of 17 youth and women under the Jeunes Leaders pour l'Innovation en Sante (JLIS) ie Young Leaders for Health Innovation who were trained in innovation design and leadership and engaged in innovation development, testing, and implementation.

A theory-driven qualitative study was conducted nationwide with 41 adolescents and youth and 16 adult stakeholders (civil society, medical providers, policymakers, etc) to understand the needs, motivations, preferences, and feasibility of digital health solutions advancing sexual and reproductive health in Benin. The social marketing for behavioral change 4P marketing mix was used to identify characteristics and strategies to increase innovation adoption, diffusion, and maintenance among adolescents, youth, and women, assess potential barriers and facilitators to implement the innovation and analyze the inner setting, outer setting, and the process.

Overall, the solution facilitates access to SRH information, commodities, and services, primary care, and improves SRH outcomes while strengthening the capacity and engagement of the Young Leaders for Health Innovation in the development, and implementation.

We primarily serve adolescents and youth with respect to their diversity and identity. Our solution is simple, user-friendly, targets users both in urban and rural areas, and does not require advanced health or tech literacy. This population lacks access to basic health information, health services, products, and commodities. The same holds true for youth facing a greater risk of discrimination, rights violations, and stigma. This platform helps them exercise their right to healthcare, empowers them, and acknowledges their autonomy. Our solution provides tools to control their own bodies and sexuality and overall well being

Young adults are also welcome to use services our sexual reproductive services or primary care services.

Our team is well-positioned to deliver for the following reasons:

Our innovation builds on a clear stakeholder engagement strategy, which helped tailor it culturally and based on needs. A total of 17 Young Leaders for Health Innovation, 16 stakeholders, and 40+ community partners were involved in the solution design and test. We look forward to sustaining these partnerships with local decision-makers to ensure sustainability. We will also continue to seek national actors' and policymakers' technical expertise. These steps will ensure a timely scale-up with the aim to reach more users across Benin and in the future, francophone Africa. 

Belonging to target communities: Our team members come from diverse backgrounds with deep ties to the target communities

Cultural competence and humility: We know the cultural, societal, and social nuances related to sexual and reproductive health in Benin, community perceptions, and ways to build trust with the community

Partnerships and coalition building: We build on relationships established by the Young Beninese Leaders Association through the SSR TECH Project ( Sante Sexuelle Reproductive et Technologies) with NGOs, government, and healthcare organizations.

Youth and Community-driven approach: 1) 17 youth and women under the Jeunes Leaders pour l'Innovation en Sante (JLIS) ie Young Leaders for Health Innovation who were trained in innovation design and leadership and engaged in innovation development, testing, and implementation.2) 41 adolescents and youth and 3)16 adult stakeholders (civil society, medical providers, policymakers, etc) involved in designing and testing the application.

Multidisciplinary expertise with experts in sexual and reproductive health,  artificial intelligence, digital health, public health, behavior sciences, social marketing, business

 Solution alignment to country's priorities (Policies such as The law “Loi n° 2003-04 du 03 mars 2003 Relative à la Santé Sexuelle et à la Reproduction' and The “Stratégie Nationale Multisectorielle de Santé Sexuelle et de la Reproduction des Adolescents et Jeunes au Bénin 2010-2020s) 

Our team's qualifications and values

The project lead is under 35 years old and has an advanced knowledge of youth health issues. Dr Joannie Bewa is a family medicine physician and executive director of the Young Beninese Leaders Association. She is also a mixed-method socio-behavior researcher who holds a doctorate degree in medicine (MD) from the University of Abomey Calavi (Benin), a master’s degree, and a Ph.D. in public health (University of South Florida, (USA). Her research and practice are related to adolescent and youth sexual and reproductive health, pregnancy outcomes, and contraceptive use and health technologies. Ten years ago, she was a founding member of the Benin UNFPA Youth panel, and attended various Commission on Population and Development negotiations. As a senior consultant, she conducted the first feasibility study for the use of technologies for SRHR in Benin in 2016 which led to the design by UNFPA and partners of a mobile application for youth. Her collaborators include talented professionals in business administration and marketing, youth participatory approaches, innovation, and medical administrator with 30+ years in gynecology and obstetrics and a team of outstanding developers and coders

Currently, 100 people are using the digital application

An additional 50 people have been involved in the innovation design

We are providing an innovative, friendly, confidential, culturally tailored, and integrated mHealth and telehealth platform to vulnerable and underserved adolescents and youth in Benin, most of them having access to smartphones. 

Our innovation resides in the following points: 

1. Increase health demands and reduce barriers to care

2. First online platform to provide both sexual and reproductive health and primary care information and services while connecting beneficiaries to providers through telehealth

3. Service integration: Contraception, HIV/ STI prevention, psychosocial and mental health support, preventive and primary care

4. Multiple offers: Appointment management, teleconsultation, referral, information, geolocalisation, E-shop

5. Multi-platform approach including a mobile app, embedded telehealth platform, and WhatsApp calls

6. Theory-based and builds on extensive formative research, guided by behavioral science and social marketing 

Our innovative solution is youth and women-centered and helps address youth, adolescents, and women's most important needs: by improving sexual and reproductive health knowledge, increasing contraception uptake, preventing unintended pregnancy, STIs/HIV infection, reducing abortion among underserved women, adolescents, and youth while valuing and respecting user's diversity and sexual orientation. Our platform removes barriers by providing unbiased, friendly, and culturally tailored information, telehealth services, and referrals. 

So far in Benin Republic, SRHR solutions target access to information solely without integrating other needs, nor are designed and guided by a behavioral theory to ensure intervention effectiveness and impact. We are changing the SRHR and healthcare ecosystem in Benin by providing digital and integrated solutions that give the power to adolescents, youth, and women to design their own plan of care by seeking immediate access to providers through telehealth, information available, and being referred where relevant. 

Our solution approaches the problem in a new or significantly improved way by leveraging the power of new technology to provide timely, quality, available, and accessible services. It could catalyze broader positive impacts by improving broad health literacy, health-seeking habits, and behaviors, and trust in the healthcare sector. This innovation will set the standard for quality and accessibility to care and can change the healthcare market considerably

The target goal is to reach 20,000 users within the next five years.

Outcome 1: By the end of 2024, reach 2000 users in Benin

      Output 1.1: 2000 adolescents, youth, and young adults enrolled in DOTOH

      Output 1.2: 1 organizational-level users enrolled

      Output 1.3: 2000 additional downloads of the DOTOH App

Outcome 2: By 2028, scale up DOTOH to 2 other African countries

     Output 2.1: To enroll 20,000 individual users

     Output 2.2: To enroll 10 organizational-level users

     Output 2.3: One mobile unit is secured for outreach to hard-to-reach                               communities

     Output 2.4: Integrate DOTOH in at least one country's healthcare system                           and /or large health provider system

Outcome 3: Strengthen the expansion, partnerships, and tech infrastructure development plans

·        Output 3.1: Establish formal partnerships with Pharmaceutical companies such as Organon and facilitate access to their reproductive health products, UNFPA, WHO, Ministries of Health, Education, and Gender

·       Output 3.2: Sustain funding with a runway of 2 years at any time.

·        Output 3.3: Strengthen tech infrastructure, develop new functionalities and integrate AI/ Machine learning and IoT

·        Output 3.4: Measure impact and develop learning / best practices materials

Overall outcome: Improve sexual and reproductive health outcomes for adolescents and youth as well as general health status by removing geographic, financial, interpersonal, stigma, and socio-cultural barriers to SRHR care.

Activity 1: To utilize co-creation, youth meaningful engagement, and participation as part of continuous improvement, outreach, and marketing efforts

Outputs:  Number of youths/youth networks involved in quality improvement and marketing efforts; number of youth networks involved in the solution

 Activity 2: To increase the access to and utilization of quality and timely healthcare services via DOTOH.

 Outputs:  Number of DOTOH downloads, number of total users, number of daily active users, number of appointments booked, number of teleconsultation sessions, number of referrals,

Activity 3: Develop community outreach and partnership strategies to increase local community buy-in and utilization of services.

Outputs: number of people reached during outreach, number of people using DOTOH from outreach sessions, contraceptive uptake, unintended pregnancy prevalence, number of countries in which DOTOH operates,  level of integration to host country’s health system.

Full time: 2

Part-time: 4

Contractors: 8

Volunteers: 17

We have been working on the solution since 2022

The staff involved in the design and overall implementation is diverse. We are supported by a team of tech contractors and volunteers made up of 50% women and 50% men. We value staff, volunteers, and users’ diversity and respect differences. Our work is community and people-centered and aims at empowering our community, we firmly believe in the protection of all individuals with no discrimination or stigma. In addition, we believe our users have the power and knowledge to make the best choices and decisions for their health. We comply with all national and international safeguarding principles and remain driven by providing quality care for all.

DOTOH has previously been supported by grants from Grand Challenges Canada and operational technical support from the Young Beninese Leaders Association (YBLA). While grants remain our main financial resource, our sustainability goal is to 1) work with healthcare providers to incorporate DOTOH into existing healthcare systems 2) work with schools or companies who can subsidize a package of service or consultation 3) require a small user fee

Overall, our strategy includes:

1. Grants and support from social impact organizations

2.   Revenues: Small fees for providing healthcare services. In the future, we will add laboratory services and additional specialties.

3.   Service Contracts with Governments by providing essential healthcare services for clients enrolled in public and government programs.

4.   Partnership with the private sector and big pharma

5.   Local health clinics and Insurers to offer virtual healthcare packages to their established network of clients.

6.   Equity and investment