While those hoping to return to the board after this year's elections were coy about possible service cuts, retiring member Katie O'Connor (Southland) spoke of the "reality that there will probably have to be cuts in health services" because of the board's deficit of about $15 million.
Dr Malcolm Macpherson (Otago) said financial viability almost crowded out all other discussion even though "there is lots of other good stuff we need to focus on".
The board could spend more time talking about clinical viability if it did not need to be so concerned about finances, he said.
It was important that the current range of services and also medical education were retained.
"We are on the edge of the rest of New Zealand and we have to hold our corner as long as we can in the South."
Chairman Errol Millar said he knew the deficit "is the first thing on everybody's mind", but the board had to make sure it had viable, sustainable services.
His Southland deputy, Paul Menzies, said the biggest challenge facing the board was its financial state.
Former Otago board chairman Richard Thomson saw the key issue as a revenue problem rather than an expenditure one.
In some areas the board was more efficient than its peers and higher spending than the national average on aged care and mental health did not come close to explaining the deficit and "over funding" position.
It was difficult to see where further costs could be removed without reducing services to below national averages - "that's the biggest issue".
Southland member Tim Ward said the biggest challenge for the new board was finding a balance between people's expectations and balancing the budget.
Dr Branko Sijnja (Otago) said as well as the board's financial health, reducing staff turnover by making the board a good place to work was a top priority.
Southland member Dot Wilson, who is in her second term on the board, and "contemplating" standing again, said the biggest challenge for the new board was its vast size.
Ensuring management and board members understood the complexity of the area was crucial, she said.
Retiring Otago member Judith Medlicott saw prioritising funds fairly to meet as many health needs as possible as the top issue.
Southland member Karen Goffe, who does not expect to be reappointed, said the board had some big tasks ahead, including how the new primary health organisation would work and the changes being mooted for rural hospitals.
Neville Cook (Southland) said the board was the most efficient in the country at delivering health services, but was not doing it within its funding.
Susie Johnstone, who was the deputy chairwoman of both previous boards, said the new board would have to focus on melding the organisations and working hard to get clinical sustainability.
The board also had to work hard on reducing the deficit - "we're expected to do something about it and we need to face up to that".
Kaye Crowther (Southland) said providing aged care within funding was an important issue along with clinical sustainability, including addressing such matters as the ageing general practitioner workforce.
Louise Rosson also spoke of the need to address particular needs, giving special mention to those of the elderly and the very young.
Fiona McArthur said the board faced "very difficult times" as it tried to maintain good access to health services across the region and meet its budget.
Peter Barron said the board could not invest in new services or capital replacement while it continued to run a deficit.
He was keen to see progress on reducing the 12% of expenditure spent on pharmaceuticals both in hospital and the community by reducing waste and using medicines more effectively through ensuring patients, doctors, pharmacists and hospitals worked together rather than operate in their own "silos".
Louise Carr said while the board's major concern was how to provide responsive health and disability services within its means, it was not all about cutting and deficits, but having a vision for the future the board could work towards.
