This is the second piece in a series produced by Acumen Academy and 100x Impact, exploring what it takes to achieve outsized impact while staying rooted in purpose. The first piece, with Samina Bano of RightWalk Foundation, examined the inner game of scale — the mindset and moral clarity required to lead through complex systems. This second piece asks a different question: once the mindset is there, what kind of model actually allows impact to grow?

 

For Sara Saeed, the co-founder and CEO of Sehat Kahani, the answer has never been a single product or breakthrough. It has been the architecture of the model itself: how care is delivered, who gets included, where revenue comes from, and whether the system is built to work for the people it was intended to serve.

Sehat Kahani sits at the intersection of two structural failures in Pakistan: the lack of quality primary healthcare in rural and low-income communities, and the exclusion of thousands of trained female doctors from the workforce. Sara saw these were not separate problems, and that if connected in the right way, they could become part of the same solution.

"I'm from a middle-class family in Pakistan where, if you had the means to educate your daughter, the dream was often for her to become a doctor," she explains. "It raised your social stature, it was culturally accepted, and it was seen as a respectable path for a woman. From a very young age, I was told I had to become a doctor."

But once she arrived in medical college, she began to see the contradiction clearly.

"Women made up 90% of my class but many were being trained as doctors while also being prepared for lives in which they might never actually practice. I experienced parts of that reality myself. I got married in my final year, had a child during my postgraduate training, and eventually found myself unable to continue working in the way I had imagined. In Pakistan, there is a term for this called the 'doctor bride.'"

The tension between women being trained as doctors and then pushed out of practice — even as communities lacked care — became the starting point for Sehat Kahani. The idea itself arrived not through research or planning, but through a practical improvisation.

"Around that time, I had been working in a low-income community clinic and saw the difference even one doctor could make," Sara says. "When I moved away, the nurse there began calling me because they could not find anyone to replace me. We started improvising with video consultations using a basic laptop and webcam. From another city, I could still help solve the same problem. That was the beginning of the idea."

Designing for scale

Sehat Kahani first built telemedicine-enabled clinics in low-income communities, connecting patients to women doctors remotely. When clinics alone proved insufficient for financial sustainability, the team built a mobile app. Adoption was initially slow, until COVID changed the landscape. The government adopted the app during lockdowns, usage surged, and although that version was free, it proved the model could work at scale. That opened the door to a corporate version of the app, which became a critical revenue channel.

"Two factors really helped us achieve scale," Sara says. "The first is our B2B model. We solve a real challenge for health insurance companies in Pakistan. They pay a lot in claims because people do not have access to quality primary care. Our app becomes that alternative. When people see a doctor early, they don't end up in hospitals, and insurance companies do not have to pay those larger claims. We solved a clear business problem for them, and that helped the model scale."

"The second is our B2G model. The government is the ultimate scale partner. But governments in countries like Pakistan do not usually pay for early innovations, so it took us a long time to push that model through. Now, three governments in Pakistan use it. We went from being laughed at for saying telemedicine could work to having governments convert dormant basic health units into telemedicine centers and partner with us to staff and run them."

Today, Sehat Kahani is one of Pakistan's largest telemedicine networks — 81 clinics across the country, a network of around 7,500 doctors, and 4.6 million consultations completed. The model's strength lies not in any single channel, but in the way its pieces reinforce one another: physical clinics, remote doctors, digital access points, and care continuity. Scale came not from doing one thing faster, but from building a system that worked for the complexity it was trying to solve.

Holding on to the whole model

During the company's pre-Series A raise, Sara kept hearing the same advice from venture capital investors: shut down the clinics. A VC-backed company needed higher burn, higher revenue, and faster growth — and the clinics were slowing them down. Some investors even suggested hiding that part of the business from the pitch entirely.

"For a moment, I did consider it," Sara says. "I thought, maybe I should separate the two, rebrand the clinics, get someone else to run them, and focus only on the app. But every time we discussed it, there was uneasiness."

"My co-founder and I asked ourselves what we had set out to build. Providing healthcare to the last mile was our first vision. We built the app to support that vision — the clinics matter to us. So we decided to pitch the whole company together. That led to a lot of rejections, but we were determined that whoever invested in us had to buy into the full vision."

The pressure has not let up. Investors still ask why the clinics are part of the business. Donors ask why the app matters at all. Each side tries to simplify the company according to its own logic. But for Sara, the point is precisely that the pieces work together.

"Pakistan is 60% rural," she says. "If I only have a product for less than half the country, then how am I solving the challenge of primary healthcare for all? If I'm leaving behind the people who deserve healthcare the most and who do not have physical doctors available, then how am I solving the challenge?"

"The tagline of the company is 'democratizing primary healthcare access for all,' and that 'all' really means all. Doing it through only one vertical would not serve my purpose."

For Sehat Kahani, the hybrid structure is not an inefficiency. It is the main point.

Building an institution that can outlast the founder

As Sehat Kahani expanded externally, Sara and her team were also building internally — ensuring that growth would not remain dependent on founder instinct alone.

That shift began earlier than most people know. "Acumen came very early in my founder journey and really changed me as a person," she says. "I had built a company called doctHERs, then demerged it two years later and rebuilt it. I don't think I would have made that decision if I had not done the Acumen Fellowship. The idea of doing what is right and not what is easy really stayed with me." Acumen also brought credibility at critical moments — particularly during COVID, when external trust opened doors for women founders in Pakistan that might otherwise have stayed closed.

100x built on that foundation in a more operational direction. "Part of building an institution that can outlast me is building an organization that is system-focused rather than founder-focused. 100x Impact helped us think more deeply about systems, M&E, accountability, and quality," Sara says. "How do we make sure we are not only providing good healthcare, but doing it efficiently and consistently, in a way we can track and prove? How do we make sure that KPIs around operations, quality, and feedback are handled through a system rather than being founder-enabled?"

That willingness to imagine the company beyond herself is part of what makes Sehat Kahani feel like an institution rather than a founder story alone.

"As a founder and CEO, you eventually come to know the edge of your own capacity," she says. "I have taken the company from one consultation to about 5 million, but maybe taking it from 5 million to 50 million requires a different skill set. And I am ready to let go and give that to someone who can do it better, or to a team who can do it better."

Building beyond the organization

When asked what success looks like beyond what she can currently imagine, Sara does not talk first about market share or company growth. She talks about changing patient trajectories across Pakistan.

"Pakistan suffers from a lack of quality primary healthcare, and that creates a huge burden across many diseases and health conditions," she says. "If our work succeeds at real scale, it should change patient trajectories across the country. It should shift people from getting care only after they become sick to getting support earlier, at the primary healthcare level."

"If we know that a patient has high blood pressure, how do we prevent them from having a heart attack? If we know they are predisposed to diabetes or are pre-diabetic, how do we make sure they do not become diabetic, or are managed better? That is the real goalpost: not just more consultations, but better long-term health journeys for millions of people."

Staying rooted while building big

For founders trying to grow in fragile systems, Sara speaks candidly about the pressure — from investors, from expectations, from the temptation to say yes when something feels misaligned. What matters, she says, is having people and practices that bring you back to yourself.

"We have investors who push us. Sometimes we know they are not saying the right thing, but we still have to listen. Sometimes we feel pressured to say yes. Sometimes we take a stand and say no. Having two founders helps. If I am leaning toward something only because I feel pressured, my co-founder will say, 'No, we cannot do this.' And I do the same for her."

"Your ethical line also becomes very important. There is bribery, corruption, and all kinds of compromises available to you. I am doing a project right now that was delayed by a year because I did not pay a bribe. Eventually it happened, but it took a year, a lot of relationships, and a lot of effort. You have to know what you will not do, draw that line clearly, and stick to it."

"As you grow, you begin to understand who you really are versus who you thought you needed to be for the world. You have to ask yourself: is this right for me, or am I only doing it because I feel pressured? Eventually, you need something in your life that acts like a mirror and tells you, this is not who you are. Once you see that, you take the decision, think through the consequences, and grow with them."

Sara's story is a reminder that meaningful scale is not only something a founder drives, it is something they architect. The model has to be designed to hold together under pressure, to serve the full complexity of the problem, and to stay true to its purpose even when the easier path is right in front of you.