This paper examines an ongoing mobile health (mHealth) initiative in Sierra Leone. The objective is to describe the ontological perspective and methodological approach used which relies on critical realism and Archer’s morphogenetic approach. Such a critical realist-based approach addresses many of the concerns associated with the interpretivist and positivist philosophical duopoly that has dominated the ICT4D field for many years. The approach allows the mechanisms that determined what caused the events associated with the mHealth case to be hypothesized, thus making clear why this mHealth case has sustained through many challenges.