OBJECTIVES: Health Insurance Organization (HIO) is the governmental health insurance in Egypt, since 1964, covering specific population segments in the community, as salaried public and private sector employees, pensioners, widows, school students, pre-school children, female headed households and farmers. The current population coverage rate is 58% of the (around 50 million people). HIO is expected to lead the transition to universal health coverage (UHC), planned in 2020. However, HIO is facing many challenges that could hamper this leading role. Those challenges affect all the five Control Knobs of the health system, identified by World Bank, fading the financial situation of HIO. Consequently, quality of service provision (both clinical and service aspects) is affected, and ultimately jeopardizing beneficiary satisfaction and financial protection. This paper discusses the process of driving a policy change, led by HIO, mandatory on the road to UHC, in Egypt, as a model for challenging emerging markets. METHODS: A cross-functional task force representing the medical, financial, administrative and legal departments, in HIO, was formed to identify and analyze environmental factors, using DEPLESET model, and identify and analyse stakeholders. A multi-criteria decision analysis (MCDA) was conducted to develop evidence. Kotter’s model for change was used to develop a policy change plan to convince key stakeholders with the required changes.  RESULTS: Improving HIO financial viability will strengthen the purchasing power of the organization, which will help advance reimbursement of healthcare providers and pharmaceutical and medical suppliers, expand the contracting capacity of HIO, which in turn, will enhance patients’ choice through competition between healthcare providers. Nevertheless, the road to reaching a political consensus, even for the most righteous decisions, requires thorough and scientific navigation process. CONCLUSIONS: Getting such a politically critical decision to be implemented, especially in economically struggling economies, requires a systematic approach to driving change.