A single new board called Southern DHB should replace the Otago and Southland District Health Boards in July, the boards' chief executive, Brian Rousseau, recommends.
If his proposal is accepted by the boards and the Government, Otago would have four elected board members and Southland three.
His report recommending the merger also says keeping two boards is holding back progress on shared clinical services.
Mr Rousseau wants priority given to creating a single provider of services.
On Thursday, the Otago board will discuss his report recommending the merger.
The Southland board will consider the matter a week later.
Thursday's meeting will be the first board debate on the issue open to the public.
Last year's decisions by the boards to proceed with consultation on the issue were not open to the public.
Mr Rousseau will ask the boards to recommend that the Minister of Health, Tony Ryall, undertake the "necessary ministerial actions" to form the new board by July.
These would be needed by April to allow enough time for board elections in October.
Mr Rousseau's recommendation follows recent public and staff consultation which attracted 212 submissions and which narrowly favoured the merger.
About half the submissions from Southland opposed the move, while Otago responses were generally favourable.
In his report, Mr Rousseau said the benefits of having a single board outweighed the disadvantages "and this appears to have public support based on the views expressed in the very modest response".
However, he is suggesting three Southland members elected by Southland voters, and four Otago members, elected by Otago people instead of the usual election at large.
This would ensure sufficient representation to protect minority interests in Southland and would be a pragmatic response to addressing representation concerns, he said.
Representation worries were expressed in about a quarter of the consultation responses with fears that Otago would dominate Southland and rural voices could be overlooked.
Mr Rousseau said he also wanted board members to reinforce the need for developing "greater engagement" between Otago and Southland senior clinical staff by giving priority to creating a single provider of services.
The consultation showed fear from Southland of a drift of services and specialists to Otago with the ultimate demise of Southland Hospital.
It was clear from discussions with senior doctors in Southland they believed their interests would be protected only by retaining the existing board structure, Mr Rousseau said.
The issue of loss of services from Southland Hospital was a "very real concern, irrespective of whether there are one or more DHBs".
If services were lost, there was no doubt that providing alternatives would result in higher costs and making access to services more difficult.
The boards' existing shared vision had addressed this issue in its aims to put the patient first and to deliver services as close to home as possible.
Referring to moves towards shared clinical services, Mr Rousseau said while there had been some gains, progress had been less than satisfactory.
