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When then health minister Jonathan Coleman fired the previous board in 2015, he did so because its deficit stood at $27million and was projected to possibly hit $42million.
After four years of being led by a commissioner team, the SDHB is weighed down by a $40million deficit, which is projected to rise markedly as one-off costs relating to the Holidays Act and health IT system write-offs are factored in.
While democracy is returning to the SDHB, that does not mean an end to central government supervision.
A Crown monitor had been in place for several years before the former board's tenure was abruptly ended, and Health Minister David Clark has said he will reinstall a new monitor to assist the incoming board.
That new board will need all the help it can get.
Quite apart from that enormous deficit, the SDHB has been assailed by troubles in recent years.
Waiting lists for several services have reached the critical level where "recovery plans" were put in place to get people their much-needed procedures.
Damning reports have been released in recent weeks about the gastroenterology, allied health and neurosurgery services, and questions have been asked about the workplace culture at the DHB.
On the plus side, the Government has signed off on replacing the increasingly dilapidated Dunedin Hospital, an upgrade to Lakes District Hospital is progressing well, and the SDHB will hopefully benefit from increased funding for cancer and mental health services.
District health board elections are notably difficult to predict as turnout is usually low; making the SDHB race even harder to pick is the large field and the lack of any incumbent board members with a record to stand on.
That said, among those standing are former SDHB board members Neville Cooke, Kaye Crowther and John Chambers - people who may feel they have a point to prove concerning their controversial ousting.
Also in the field is Malcolm MacPherson, who served four terms on the Otago and then the Southern DHB, before standing down in 2013.
The surprise candidate in the field is outgoing Dunedin Mayor Dave Cull, who has made no secret of his desire to be named chairman of the board - a decision which is the prerogative of Health Minister Clark.
There is no doubt Mr Cull has greater name recognition than his rivals, but he will have to convince voters that his local government experience can cross over to the health realm.
Another notable politician with their hat in the ring is former MP and current Invercargill city councillor Lesley Soper.
As you would expect, many of the candidates have extensive health sector experience, including former SDHB medical officer of health Marion Poore, radiation oncologist Lyndell Kelly, former Oamaru Hospital emergency medicine specialist Peter Rodwell, SDHB mental health and addictions network chairman John MacDonald and respiratory physician Roland Meyer.
Hoping to bring an outsider's perspective are economist Benje Patterson, lawyer Ben Nettleton, businessman Rob Woodhouse, Community Health Council member Ilka Bekhuis, accountant Jason Bauchop and engineer Andrew Velman.
With 17 candidates for the four Otago constituency berths and 11 in the running for three Southland seats, some experienced and capable people will definitely miss out.
Hopefully, the voters, in their wisdom, select a board up to the herculean challenge ahead.