The Southern District Health Board is overhauling its senior management to complete a merger process begun two years ago.
The Otago and Southland DHBs joined in April 2010 but the combined board retained separate managers for some medical areas.
A National Health Board review last year recommended the new board urgently complete its merger.
New chief executive Carole Heatley has restructured the executive team since her appointment in April.
On Monday the DHB released a proposal to disestablish 29 Otago and Southland roles and replace them with 18 district-wide leadership positions.
Staff have three weeks to make submissions on the proposal.