Tuberculosis case detection and treatment success rates in the country of Ethiopia trail those of neighboring sub-Saharan African countries, despite comparable application of DOTS . This paper is the first of a two-part series to theoretically and practically assess ways in which models of cultural competence and behavioral economics can be implemented to improve TB outcomes in Ethiopia. In this first article, perceived irrationality on the part of the TB patient will be explained via application of behavioral economics. Three tenets of behavioral economics are defined and analyzed: loss aversion, hyperbolic discounting, and social bias. These components are then used to describe the ways in which cultural competence can be re-evaluated in the context of global health, with emphasis on tuberculosis in Ethiopia. The analysis concludes by offering the Purnell Model of Cultural Competence to parse the patient irrationality as perceived by providers (and identified via principles of behavioral economics) from the inherent cultural norms of the patient to better inform TB control efforts.
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