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The international conference on primary health care held in Alma-Ata (former Soviet Republic) from 6 to 12 September 1978 underlined the need for urgent action by all governments, all health and development workers and the international community to protect and promote health for all. Togo, a small country in West Africa with a growing population (5,556,812 inhabitants in 2004), faced with a completely dilapidated economic situation, has signed up to Primary Health Care and in its National Health Policy (PNS) adopted in 1998, has taken good account of the resolutions of this conference, but the reality on the ground seems to be quite different. Population dynamics are leading to internal migration (from rural areas to urban centres) in search of better living conditions.