The paper addresses the wicked problem of unsustainable health information systems in the context of low and middle income countries (LMICs), specifically using a case study from India in the public health sector. The paper makes the argument that current analysis of sustainability tends to be largely “supply-driven” focusing on the provision of external resources and technical assistance needed to sustain a project. But since these external injections are self-multiplying, requiring more and more over time, they tend to not lead to satisfactory and sustainable solutions. The paper argues for a more “demand-driven” approach, where the focus is on the user and the use context. Taken from this perspective, the paper identifies two sets of processes – evolving local ownership and enhancing use – as being key to establish sustainability. Further, these processes are seen to be mutually self-reinforcing, and supported by an enabling context of use.