Abstract: Rural domestic sewage treatment (i.e. RDST) is of great significance for promoting ecological protection and high-quality development of the Yellow River Basin. Taking the counties in the Yellow River Basin as the basic statistical units, the rates of RDST in the counties were calculated, and the following problems were found. 1) The RDST was unbalanced in overall progress and varied significantly among the Yellow River Basin's upper, middle, and lower reaches. 2) In terms of the population concentrated areas, the rates of RDST were low in some areas of Henan. 3) RDST of township government residents, and central villages had not been fully covered. 4) The RDST level of the key river basins was low, including the Wuliangsuhai Lake, and the Sushui River. Finally, the unclear connotation and implementation way of Resource Utilization led to the possibility of inflated RDST in the upper and middle reaches of the Yellow River Basin. Therefore, to promote the RDST of the Yellow River Basin in the 14th Five-Year Plan, we should identify the bull's eye to highlight key points. 1) Accurate treatment areas are required, including the areas with low rates of RDST, and the Wuliangsuhai Lake, Sushui River and other key river basins. 2) Accurate measures are required. The collaborative treatment of the rural domestic sewage and water environment should be highlighted, thus striving to solve prominent pollution problems of water. 3) Accurate assistance is required based on the characteristics of the upper, middle, and lower reaches of the Yellow River Basin. The definition and implementation path of Resource Utilization should be further clarified.