Abstract: In many rural areas across China, sewage treatment efforts often exhibit a pattern of "emphasizing construction but neglecting management" with notable lack of long-term operation and maintenance mechanisms. To enhance the effectiveness of rural sewage treatment, this study applies game theory to analyze the relationships and evolutionary dynamics among the three primary stakeholders involved in the operation and maintenance process. Based on the game analysis and real-world conditions, an evaluation index system was developed, focusing on three dimensions: effectiveness, cost, and management. To determine the relative importance of each indicator, the Analytic Hierarchy Process (AHP) was employed, resulting in a scientific, comprehensive and practical evaluation method for rural sewage treatment operation and maintenance. An empirical analysis was conducted using real-world data from a rural sewage treatment project in Danzhou City, Hainan Province. The results validate that the evaluation index system aligns well with the actual conditions of rural sewage treatment practices. Based on the evaluation findings, targeted management strategies and policy recommendations are proposed. These can serve as a reference for government authorities in assessing and overseeing the performance of rural sewage treatment service providers.