In the wake of “the mobile revolution”, there has been an immense surge in mobile phone-based health innovations. Scholars and industry specialists have found a large portion of such innovations in less developed economies unsustainable beyond pilot projects. However, “sustainability” is a difficult aspiration to operationalize. Based on insights from recent literature on digital innovation, the paper suggests an alternative focus on generativity – a perspective on longevity that emphasizes the continuous facilitation of innovation over stewardship and control. To illustrate the relevance of generativity to ICT4D, the paper draws on examples from a mobile phone-based implementation to strengthen routine reporting of public health data in Malawi. By foregrounding generativity as an ICT4D aspiration, the paper begins to consider implications at the level of projects, national policy and international development collaboration.