When pH = pKa you have equal amounts of acid and the conjugate base (or a base and a conjugate acid).
So, a buffer works best if you have a 1:1 mixture of an acid and its conjugate base (like at pH=pKa). Because then it can resist changes if you add an acid, since it will react with the conjugate base. Or if you add a base it will react with the acid.
Lets say you add HCl to a 1:1 buffer solution. The HCl will react with the conjugate base and won't affect the pH of the solution much because the conjugate base neutralized the acid. If you add too much HCl you will use all of the conjugate base and then the pH will increase a lot more.
So the equation pH = pKa + log ...
when the acid = conjugate basic concentration the log 1/1 = 0 because log 0 = 0. If you do not have equal amounts of acid and conjugate base the log term will not be 0 and this affects the pH, but you will still have a buffer! Anytime you have an acid and a conjugate base it is a buffer. Say you have 4 mols of and acid and 2 mols of its conjugate base. It is still a buffer. It is not as good since you don't have equal amounts of both, but still a buffer.
A buffer region is not just pH = pKa. pH = pKa is where the best buffer is. The entire buffer region is from the region pH-1 to pH+1.
Check this picture
http://facstaff.gpc.edu/~mkim/C1211&1212Lec/16_BufferRegion_TitrationCurve.jpg
The best buffer is at pH 4.77. But there is a buffer region anywhere from pH 4 to pH 6.