Abstract: Objective To analyze the trend of drinking water quality in rural areas of four counties in Henan Province, which were located in Huaihe river basin, to provide scientific basis for the comprehensive prevention and control of cancers. Method The quality of drinking water monitored in 2010-2013 were analyzed and evaluated by the Sanitary Standard for Drinking Water (GB 5749-2006). Results The total qualified rate of 1024 water samples collected from these four counties was 43.8%; and the pass rate in each year was improved in the four years (χ²=14.02, P < 0.05). The highest pass rate was 61.5% in samples from X County and the lowest pass rate was 25.4% in samples from S County. There was a statistically significant difference among four counties (χ²=86.33, P < 0.05). The qualified rate of water from decentralized water supplies was less than the water from centralized water supplies (χ²=145.8, P < 0.05). No statistically significant difference was observed between the water quality collected from dry and wet seasons in 4 counties (χ²=1.79, 1.4, 0.38, 1.43, P＞0.05). The qualified rate for microbiological indicators was 72.7% and fluoride was 85.7%, which were the most important influential factors for improving the comprehensive index of water quality. Conclusions The quality of drinking water in rural areas of these four counties in Huaihe basin had been improved continuously in 2010-2013, but the problem of microbiological indicators and fluoride, which were out of the standard limits, was still serious.