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In January 2025, President Trump immediately paused US foreign development assistance, upending healthcare in many low- and middle-income countries. The scale of the lost funding is substantial. The US administration terminated 86 per cent of USAID programmes worth $75.9 billion. The impact of these reductions on African health systems and governments will be considerable. With limited resources to cover financial shortfalls, already neglected African palliative care organisations will be further deprioritised, subsumed under more cost-effective disease prevention and treatment programmes. We outline practical areas to herald an era of hybrid funding models to help ensure financial stability and organisational longevity.