Hospital services remain poorly managed in African countries and in particular in Benin. Effective management must promote strategic planning and implementation of resources to achieve desired goals. The purpose of this article is to describe elements contributing to the poor performance of health care facilities in Benin and more particularly the response of hospital management within the framework of ongoing reforms. Analysis also focuses on strategic priorities and the central role of the human factor in any action to organize management. Implementation of participative management in the Beninese hospitals still requires great improvement in numerous areas including integration of health facilities into an open system, reinforcement of continuous education programs for personnel, recruitment of qualified technical personnel, and creation of training modules in hospital management.