Saira Siddique's medIQ builds in Pakistan and earns in Saudi Arabia

Five years of TBT and a new series with Endeavor

Muzamil opens with an anniversary. Thought Behind Things started about five years ago, and close to 450 episodes are now online. He calls it the largest catalogue of conversations in Pakistan. After the podcasting boom, he says, about 95% of the new entrants who came for quick fame have left. He is taking the show back to its roots: startup founders, business leaders and economists, three episodes a week. The new season is a partnership with Endeavor Pakistan, the chapter of a global network of entrepreneurs. He names Mudassir Sheikha, who sold Careem, and Uzair Gadit of Cloudways among the people on its board. The plan is 50 conversations. Every company he has recorded so far earns at least 5 million dollars in revenue, and some earn 20 to 40 million.

This is the first episode of that series. Muzamil chose Dr Saira Siddique to open it because women founders are rare in Pakistan, and because her story does not come from a big business family.

He also shares estimates from a model his team built for the series. It puts medIQ’s value at between 180 and 300 million dollars, and Saira’s own net worth at around 100 million dollars. If the company keeps growing at about 40% a year, the model expects it to pass a billion dollars somewhere between 2028 and 2030. Without the Saudi expansion, he says, the date would be closer to 2035. His wider point is about timelines: a company that only serves Pakistan should expect about ten years to reach unicorn status. He thanks Saira for sharing numbers that most founders refuse to give on camera.

An army childhood and a doctor by family design

Saira was born in Bahawalpur, the child of an army officer, and the family settled in Pindi when she was four. She studied at a convent school and did her FSc at CB College.

Her parents pulled in two directions. Her father worried about marriage in a house of three sisters and one brother, and wanted her to become a doctor so she would find a good match. Her mother was strict about education and wanted her to be independent, with a skill and a profession in her own hands. Saira says she liked medicine because it helps people. She placed third on the Federal Board. At that time Pakistan had only seven medical colleges and no private ones. She graduated in 2000.

She married during medical college. Her husband is an oncologist, and she says he still asks what she is doing in tech. Her elder daughter, now 23, was born in her final year. She did not take a break. She sat her exams and did her house job like everyone else. Her mother-in-law looked after the baby, which Saira describes as the opposite of the usual mother-in-law story.

Public health, London and a PhD paid from savings

During her house job, Saira decided she wanted to work on population programs instead of individual patients. Health gets a very small share of Pakistan’s GDP, and she believed even one dollar could go further if it was spent well and paired with technology. In 2002 she took her daughter to London for a master’s in public health at the London School of Hygiene and Tropical Medicine. The day care was on campus, and she visited her daughter four times a day between classes. Her family had given her one year.

Back home she joined USAID as a project manager and started health programs in Khyber Pakhtunkhwa and the outer areas of Punjab. She says they were running telehealth in 2002, connecting places such as Waziristan and Kandkot to large hospitals so patients could consult a doctor before travelling.

Over about ten years she worked with USAID, the UK’s DFID and the Benazir Income Support Program, which wanted a health insurance scheme for people below the poverty line. There she saw that five dollars could push a family under the line. A medical bill could force a household to sell its assets, even its buffalo.

She then left a job at KfW Development Bank to start a PhD at the University of York in 2011, paid for with everything she had saved. Her family told her to buy a DHA plot instead. She worked at convenience stores and restaurants while her daughters were at school. Her thesis compared expensive health technology with low-cost options in Pakistan and found no difference in outcomes. Results depended on patient behaviour.

Muzamil pushes on why she came back, twice, when 16 lakh Pakistanis have left in the past year and a half. Saira says she never planned to stay abroad. “Abroad, the systems are already built and people work inside them,” she says. “Here, we have to build the systems.” She argues that the room to improve things is larger in Pakistan, and that the impact reaches 240 million people instead of one hospital or one university.

Running health insurance for Punjab’s poorest

She returned in 2014 to a World Bank job. The pro-poor insurance program she had worked on was now ready for the government to implement. In a meeting attended by the Prime Minister and a chief minister, she was picked to run it. People warned her she would not survive two days in government.

She became CEO of the Punjab Health Insurance program, later renamed the Sehat program and the Sehat Insaf program. It gave families below the poverty line free hospital care, including cancer and heart treatment. The limit was 8 lakh rupees per family per year, and it could rise to 13 lakh for cases such as chemotherapy. Doctors on a helpline assessed each caller first. Outpatient cases got medicines at home. Patients who needed a hospital were called in.

She remembers a woman who had carried a three kilogram fibroid for years and walked bent forward. After surgery under the program, the woman put a hand on Saira’s head. “Thank God, an angel has come and done this work,” she told her. “Now I can walk straight.” Saira’s argument is that health and productivity move together. When poor people are treated, they work again and can leave poverty.

The money did not come easily. Saira had come from the World Bank to run the company, yet she spent a full month outside a section officer’s room in the finance ministry. “I sat there every day from 8 in the morning to 5 in the evening,” she says, to get the first cheque of 25 crore released. Her first team was mission-driven and mostly from the private sector, and they worked without pay for five months. She says the program now spends about 2 billion a year and is approaching 5 billion.

In between, she spent about two years with Allianz in Munich, studying how emerging economies such as the Philippines and Vietnam used savings products and takaful to pay for care. She came back in 2018, rejoined government, and says they took health savings products to about 18 million people through mobile wallets.

The accident on the canal road

Then her life turned over. She had reached home at 2am from another city, hugged her daughters and her husband, and sat down to eat. A call came. A chief minister, whom she does not name, wanted a report at an 8am meeting in Lahore. She left her meal and set off with her driver at about 2:30am.

It was winter, and the canal road extension in Lahore was under construction. The driver fell asleep. The car went straight into a ditch she estimates at about 35 feet deep. The driver died on the spot. Saira could feel her hands and feet going numb. She called Dr Rizwan, the head of Rescue 1122, a doctor she knew who was saved in her favourites. He did not pick up. She blacked out.

When he saw the missed calls, he called back, then traced her phone’s location and sent a rescue team. She woke in Jinnah Hospital after seven days in a coma. Her father, her husband, her daughters, the chief minister and Dr Rizwan were around her. Her first question was whether her younger daughter had eaten. Then she tried to reach out and touch her, and her hand did not move. The doctors told her she was paralysed from the neck down.

She had about 14 surgeries on her spine alone, plus fractures, and her face had to be rebuilt. As a Canadian citizen she was treated in Canada and the US. Her elder daughter spent a year and a half without her mother, and her younger daughter, about 12, cried every day after school. Saira had run an organisation of 500 people, and now she wondered if people would have to carry her to the washroom. She decided against a life of depression. “Now the struggle is not about doing something for millions,” she says. “The struggle is: what is the purpose of life? What can I do that helps people like me?”

Building medIQ from a hospital bed

Back in Pakistan, she spent an extra six months in hospital for rehabilitation that, she says, could have happened at home with the right systems. A physiotherapist could visit, medicines could refill on their own, and reminders could arrive for tests. This was before COVID. She also saw that hospitals treat a patient’s history as their own property. In her view it is the patient’s right, and continuity of care breaks when the record is missing.

The answer was a mobile app for hybrid care, connecting online and in-person services, with reminders for refills, tests and visits. medIQ brought about 7,000 healthcare providers on board, 3,000 online and 4,000 physical, and treated 300,000 patients in three cities. All of it was bootstrapped. When her husband asked for the money they had saved for their elder daughter’s university in the US, Saira told him it was gone. She had put it into the startup. Her daughter then won a scholarship that she says covered 130% of the cost, including living expenses.

To grow past 500,000 patients, she set out to raise about 2 million dollars. Her unit economics were positive, with a 15 to 17% margin on each patient. Pakistani VCs liked her deck and her data room, but they preferred fintech, e-commerce and logistics. After 62 pitches the answer was the same. “We don’t invest in health tech,” she recalls them saying. She widened the search to Europe, the US and the Middle East. The first yes came after the 111th pitch: 400,000 dollars from a group of Pakistani diaspora doctors in the US, the first investment from their new seed division. American VCs and one Dubai-based VC followed. medIQ closed a 1.8 million dollar seed round, which she calls the highest ever raised by a solo female founder in Pakistan. She had already put in half a million of her own.

She stopped at 1.8 million because she did not want to burn money. Her focus was chronic patients with diabetes and hypertension, who come back again and again. Repeat customers were 38%. medIQ spent 1 million dollars on technology to meet the certifications an American company holds, and she says about 600 clinics in the US now use the software.

From marketplace to the plumbing behind insurers

Muzamil admits he is confused about what medIQ actually does. Saira explains that it began as a B2C marketplace and became a white-label platform. Pakistani insurers rarely cover outpatient care in real time, so patients pay first and claim later. medIQ integrated with 13 of the country’s 22 insurance companies. A customer opens the insurer’s own app and sees outpatient services marked as powered by medIQ. At a hospital such as Shifa, the visit is flagged in advance, the patient shows a digital card, and the fee comes off their limit. She says a consultation that costs the public 5,000 rupees costs a medIQ customer 3,200.

The company also serves large corporates and sells low-cost health products through telecom companies for a few rupees a day. It reached 150 cities. To make the flow work, it built software for providers too, digitising 500 hospitals, 100 pharmacies and 50 labs. In Pakistan it sold that software at subsidised rates. The payoff was clinical flows tested on 4 million customers.

Muzamil asks where the revenue really comes from. Saira separates gross merchandise value from revenue. Insurers pay 25% of a client’s outpatient premium upfront, which medIQ holds as a float under its third-party administrator licence. It earns a 10% admin fee on the funds used over the year. It negotiates discounts with providers, passes half to the customer and keeps the rest, which she says comes to about a 20% revenue share on services. Corporates that self-manage their health budgets pay 15%. Telecom customers pay daily or monthly subscriptions. Pakistan’s margin is about 18%. She gives a GMV of 61 million dollars, of which 9.53 million was revenue.

Saudi Arabia, where the software is the product

As Pakistani funding dried up, Saira spent about a month touring the Middle East. Saudi Arabia showed the most will. Health is a pillar of its Vision 2030, which targets fully digitised care, and medIQ’s system already followed American standards. She says the investment ministry process took a month and a half, against the six months people warned her about. She spent three months in Riyadh, in her words in slippers with her sleeves rolled up, and the company was functional in about two and a half months.

The government told her to bring the patient-facing engine later. The real gap was mid-tier hospitals. Saudi Arabia has more than 5,000 mid-tier hospitals and multi-specialty clinics. About 300 to 350 are government hospitals running costly systems such as Cerner or Epic, and large private groups have built their own. The mid-tier lacks the money and the know-how to turn its needs into a requirements document. Saira says her medical training finally paid off here. “Making complicated systems is easy,” she says. “Making them simple is hard.”

medIQ tested in five hospitals. One was linked to a VC who put in half a million and asked her to reach 100 sites. It took about three months, across Jeddah and Riyadh. A 0.8 million dollar bridge round paid for a bilingual Arabic system, built to handle medical terms and the region’s dialects. medIQ grew to about 300 facilities in the two cities. The new 6 million dollar Series A will take it to 15 more cities, with a goal of 25% of the market in two years, and then to Bahrain, Qatar and Kuwait. She says medIQ is already in more than 500 hospitals.

The Series A also pays for AI. Conversations between doctor and patient are recorded and turned into notes in Arabic, sent to the patient’s phone and the hospital record. She says documentation took about 75% of a doctor’s time, and that this has fallen to about 15%. “AI is helping us bring the human touch,” she says, because the doctor can now look at the patient.

In Saudi Arabia, medIQ charges a small setup fee and then about 100 dollars, or 300 riyal, per user per month. Contracts run for at least two years, and she says churn is close to zero once a hospital’s data is in the system. She puts Saudi margins at about 71%. Pakistan still produces more GMV, but 56% of gross profit comes from Saudi Arabia. In the first six months of this year, she says, medIQ made 14 million dollars in revenue, not GMV.

The work stays in Pakistan. The technology and back office are there, and the Arabic call centre is staffed by students from the Islamic University in Islamabad and by educated immigrants, including Syrians, with AI adjusting their dialect. A Saudi call centre agent would cost at least 7,000 riyal. medIQ has 107 people in Pakistan and 13 in Saudi Arabia. Saira herself has lived in Riyadh for two years. Saudis, she says, do not trust founders who fly in once a month. You meet someone about six times before you join their social circle, and founders should expect at least a year.

Raising slowly and keeping 60%

Muzamil sets up the fundraising question from two sides: founders who raise for the sake of valuations, and old family businesses that refuse outside money to keep control. He recalls an industrialist who demanded 51% of his idea-stage startup for 2 to 2.5 crore rupees. He asks Saira what dilution has looked like for her.

She calls her model hybrid. It started like a family business funded with her own money, with no waste. She also knew that going big needed outside capital. “Don’t take money for the sake of money,” she says. Her rule is to raise only enough to hit the growth target that justifies a better valuation next time. She stopped the seed at 1.8 million instead of 2. The Series A was oversubscribed with 10 million on offer, and she cut some allocations to stop at 6 million. Sharing the company felt, as a mother, like sharing her baby. She warns founders not to raise so much that they end up as a minority.

She says she still owns 60% of medIQ, and that it has served more than 15 million customers in five years. Her method is to grow first, then raise. She matches each round to investors who suit that stage, since a seed investor will not accept a 40 million dollar pre-money valuation. Some later rounds closed in three months.

Muzamil closes by saying the story goes beyond startups. “The human story is extremely powerful,” he says, and he urges her to write a book one day. Saira ends with a message for girls. People will tell them the world outside is full of wolves. She mentors many young women, including her daughters, and tells them the same thing: “Life is never going to be easy. It’s always going to be tough. But how you deal with those problems, and your attitude, is what makes you or breaks you.”